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Arabia G, Colangelo M, Borrello F, Curnis A, Ciconte VA, Arabia F. Usefulness of last generation insertable cardiac monitors in the diagnosis of unexplained syncope. Int J Cardiol 2024; 413:132301. [PMID: 38944347 DOI: 10.1016/j.ijcard.2024.132301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
AIMS Guidelines recommend insertable cardiac monitor (ICM) in the early phases of the evaluation of unexplained syncope (US) syncope, when an arrhythmic etiology is suspected. We examined the diagnostic yield of the last generation ICM (LG-ICM) to establish the causes of US, by assessing in the clinical practice the incidence of: relevant arrhythmia diagnosis, syncope recurrences and CM-guided cardiac electronic device (CIED) implantation. We investigated also baseline patient characteristics associated to an increased risk of relevant arrhythmias and of syncope recurrence. METHODS Data prospectively collected from consecutive patients receiving LG-ICM for investigation of US or presyncope in our institution between November 2020 and January 2023 were analyzed. RESULTS A total of 109 patients (mean age 64.4 ± 16.1 years, 40.4% women) with US or pre-syncope episodes underwent implantation of the LG-ICM. During a mean follow-up of 11.7 ± 8.1 months, LG-ICM diagnostic yield was 42%. In particular, LG-ICM detected cardiac arrhythmias in 29 (27%) patients (in 6 out of them during a syncope recurrence) and to exclude the arrhythmic origin of the syncope in additional 19 (17%) patients. LG-ICM guided the implantation of a CIED in 16 (15%) US patients, due to the diagnosis of asystole or severe bradycardia. Age ≥ 65 years (p = 0.012) and atrial arrhythmia history (p = 0.004) are significant independent predictors of arrhythmic diagnoses performed by LG-ICM, while CAD is predictor of syncope recurrence (bordering on statistical significance, p = 0.056). CONCLUSIONS The diagnostic yield of LG-ICM in US syncope is comparable to those of ILR and previous generation ICM. The advantages of LG-ICM should be sought in lower hospital workload necessary to manage ICM data. Age ≥ 65 years and atrial arrhythmia history are independent predictors of significant ICM-detected arrhythmias.
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Affiliation(s)
- Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Italy.
| | - Maria Colangelo
- Azienda Ospedaliera Universitaria "Pugliese Ciaccio", Catanzaro, Italy
| | | | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | | | - Francesco Arabia
- Azienda Ospedaliera Universitaria "Pugliese Ciaccio", Catanzaro, Italy
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William J, Nanayakkara S, Chieng D, Sugumar H, Ling LH, Patel H, Mariani J, Prabhu S, Kistler PM, Voskoboinik A. Predictors of pacemaker requirement in patients receiving implantable loop recorders for unexplained syncope: A systematic review and meta-analysis. Heart Rhythm 2024:S1547-5271(24)00284-4. [PMID: 38508296 DOI: 10.1016/j.hrthm.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Implantable loop recorders (ILRs) are increasingly used to evaluate patients with unexplained syncope. Identification of all predictors of bradycardic syncope and consequent permanent pacemaker (PPM) insertion is of substantial clinical interest as patients in the highest risk category may benefit from upfront pacemaker insertion. OBJECTIVE We performed a systematic review and meta-analysis to identify risk predictors for PPM insertion in ILR recipients with unexplained syncope. METHODS An electronic database search (MEDLINE, Embase, Scopus, Cochrane) was performed in June 2023. Studies evaluating ILR recipients with unexplained syncope and recording risk factors for eventual PPM insertion were included. A random effects model was used to calculate the pooled odds ratio (OR) for clinical and electrocardiographic characteristics with respect to future PPM requirement. RESULTS Eight studies evaluating 1007 ILR recipients were included; 268 patients (26.6%) underwent PPM insertion during study follow-up. PPM recipients were older (mean age, 70.2 ± 15.4 years vs 61.6 ± 19.7 years; P < .001). PR prolongation on baseline electrocardiography was a significant predictor of PPM requirement (pooled OR, 2.91; 95% confidence interval, 1.63-5.20). The presence of distal conduction system disease, encompassing any bundle branch or fascicular block, yielded a pooled OR of 2.88 for PPM insertion (95% confidence interval, 1.53-5.41). Injurious syncope and lack of syncopal prodrome were not significant predictors of PPM insertion. Sinus node dysfunction accounted for 62% of PPM insertions, whereas atrioventricular block accounted for 26%. CONCLUSION Approximately one-quarter of ILR recipients for unexplained syncope require eventual PPM insertion. Advancing age, PR prolongation, and distal conduction disease are the strongest predictors for PPM requirement.
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Affiliation(s)
- Jeremy William
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - David Chieng
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Hitesh Patel
- The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Peter M Kistler
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
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Zangiabadian M, Soltani K, Gholinejad Y, Yahya R, Bastami S, Akbarzadeh MA, Sharifian Ardestani M, Aletaha A. Predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope: A systematic review and meta-analysis. Clin Cardiol 2024; 47:e24221. [PMID: 38402528 PMCID: PMC10823547 DOI: 10.1002/clc.24221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/26/2024] Open
Abstract
Identifying the underlying cause of unexplained syncope is crucial for appropriate management of recurrent syncopal episodes. Implantable loop recorders (ILRs) have emerged as valuable diagnostic tools for monitoring patients with unexplained syncope. However, the predictors of pacemaker requirement in patients with ILR and unexplained syncope remain unclear. In this study, we shed light on these prognostic factors. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL were systematically searched until May 04, 2023. Studies that evaluated the predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope were included. The "Quality In Prognosis Studies" appraisal tool was used for quality assessment. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated. The publication bias was evaluated using Egger's and Begg's tests. Ten studies (n = 4200) were included. Right bundle branch block (OR: 3.264; 95% CI: 1.907-5.588, p < .0001) and bifascicular block (OR: 2.969; 95% CI: 1.859-4.742, p < .0001) were the strongest predictors for pacemaker implantation. Pacemaker requirement was more than two times in patients with atrial fibrillation, sinus bradycardia and first degree AV block. Valvular heart disease, diabetes mellitus, and hypertension were also significantly more in patients with pacemaker implantation. Age (standardized mean difference [SMD]: 0.560; 95% CI: 0.410/0.710, p < .0001) and PR interval (SMD: 0.351; 95% CI: 0.150/0.553, p = .001) were significantly higher in patients with pacemaker requirement. Heart conduction disorders, atrial arrhythmias and underlying medical conditions are main predictors of pacemaker device implantation following loop recorder installation in unexplained syncopal patients.
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Affiliation(s)
- Moein Zangiabadian
- Endocrinology and Metabolism Re‐search Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
| | - Kiarash Soltani
- Shahid Beheshti University of Medical SciencesSchool of MedicineTehranIran
| | - Yasaman Gholinejad
- Shahid Beheshti University of Medical SciencesSchool of MedicineTehranIran
| | - Reyhane Yahya
- Shahid Beheshti University of Medical SciencesSchool of MedicineTehranIran
| | - Shayan Bastami
- Shahid Beheshti University of Medical SciencesSchool of MedicineTehranIran
| | | | | | - Azadeh Aletaha
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of medical SciencesTehranIran
- Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research CenterTehran University of Medical SciencesTehranIran
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Doundoulakis I, Tsiachris D, Kordalis A, Koliastasis L, Soulaidopoulos S, Arsenos P, Xintarakou A, Bartsioka LI, Dilaveris P, Vlachopoulos C, Sideris S, Tsioufis K, Gatzoulis KA. Management of Patients With Unexplained Syncope: Derivation and Validation of a Simplified 2-Step Diagnostic Approach. J Am Heart Assoc 2023; 12:e031659. [PMID: 37982260 PMCID: PMC10727290 DOI: 10.1161/jaha.123.031659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/19/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The aim of this study was to develop a structured 2-step approach, based on noninvasive diagnostic criteria, that led to an electrophysiology study in patients with unexplained syncope. METHODS AND RESULTS Two independent cohorts were used: the derivation cohort with 665 patients based on electronic health record data to develop our 2-step diagnostic approach, and the validation cohort based on 160 prospectively screened patients, presenting with unexplained syncope episodes. Noninvasive electrocardiographic and imaging markers and an electrophysiology study-based invasive assessment were combined. A positive diagnostic approach according to our study's prespecified criteria resulted in a decision to proceed with a permanent pacemaker/implantable cardioverter-defibrillator. The primary end point was the time until the event of recurrent syncope (syncope-free survival). Number needed to treat was calculated for patients with a positive diagnostic approach. The number of patients with unexplained syncope and borderline sinus bradycardia needed to treat was 5, and the number of patients with unexplained syncope and bundle branch block needed to treat was 3 over a mean follow-up of ≈4 years. After the structured 2-step approach, the primary outcome occurred in 14 of 82 (17.1%) with a pacemaker/implantable cardioverter-defibrillator and 19 of 57 (33%) with a negative approach, with a mean follow-up of ≈2.5 years (29.29±12.58 months, P=0.03). CONCLUSIONS The low number needed to treat in the derivation cohort and the low percentage of syncope recurrence in the validation cohort supports the proposed 2-step electrophysiology-inclusive algorithm as a potentially low-cost, 1-day, structured tool for these patients.
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Affiliation(s)
- Ioannis Doundoulakis
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Dimitris Tsiachris
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Athanasios Kordalis
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Leonidas Koliastasis
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Stergios Soulaidopoulos
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Petros Arsenos
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Anastasia Xintarakou
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Lamprini Iro Bartsioka
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Polychronis Dilaveris
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Charalambos Vlachopoulos
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Skevos Sideris
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Konstantinos Tsioufis
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
| | - Konstantinos A. Gatzoulis
- First Department of CardiologyNational and Kapodistrian University, Hippokration General HospitalAthensGreece
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Francisco Pascual J, Jordan Marchite P, Rodríguez Silva J, Rivas Gándara N. Arrhythmic syncope: From diagnosis to management. World J Cardiol 2023; 15:119-141. [PMID: 37124975 PMCID: PMC10130893 DOI: 10.4330/wjc.v15.i4.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.
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Affiliation(s)
- Jaume Francisco Pascual
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- Grup de Recerca Cardiovascular, Vall d’Hebron Institut de Recerca, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Pablo Jordan Marchite
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Jesús Rodríguez Silva
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Nuria Rivas Gándara
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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6
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Francisco-Pascual J, Rivas-Gándara N, Maymi-Ballesteros M, Badia-Molins C, Bach-Oller M, Benito B, Pérez-Rodón J, Santos-Ortega A, Roca-Luque I, Rodríguez-Silva J, Jordán-Marchite P, Moya-Mitjans À, Ferreira-González I. Arrhythmic risk in single or recurrent episodes of unexplained syncope with complete bundle branch block. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022:S1885-5857(22)00323-1. [PMID: 36539183 DOI: 10.1016/j.rec.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with a single syncopal episode (SSE) and complete bundle branch block (cBBB) are frequently managed more conservatively than patients with recurrent episodes (RSE). The objective of this study was to analyze if there are differences between patients with single or recurrent unexplained syncope and cBBB in arrhythmic risk, the diagnostic yield of tests, and clinical outcomes. METHODS Cohort study of consecutive patients with unexplained syncope and cBBB with a median follow-up time of 3 years. The patients were evaluated via a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor. RESULTS Of the 503 patients included in the study, 238 (47.3%) had had only 1 syncopal episode. The risk of an arrhythmic syncope was similar in both groups (58.8% in SSE vs 57.0% in RSE; P=.68), also after adjustment for possible confounding variables (HR, 1.06; 95%CI, 0.81-1.38; P=.674). No significant differences between the groups were found in the EPS results and implantable cardiac monitor diagnostic yield. A total of 141 (59.2%) patients with SSE and 154 (58.1%) patients with RSE required cardiac device implantation (P=.797). After appropriate treatment, 35 (7%) patients had recurrence of syncope. The recurrence rate and mortality were also similar in both groups. CONCLUSIONS Patients with cBBB and unexplained syncope are at high risk of an arrhythmic etiology, even after the first syncopal episode. Patients with SSE and RSE have a similar arrhythmic risk and similar outcomes, and therefore there is no clinical justification for not managing them in the same manner.
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Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Nuria Rivas-Gándara
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Manel Maymi-Ballesteros
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Badia-Molins
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Bach-Oller
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Begoña Benito
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jordi Pérez-Rodón
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alba Santos-Ortega
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ivo Roca-Luque
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unitat d'Arrítmies, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Jesús Rodríguez-Silva
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo Jordán-Marchite
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Àngel Moya-Mitjans
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Servei de Cardiologia, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
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7
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Tonegawa-Kuji R, Inoue YY, Nakai M, Kanaoka K, Sumita Y, Miyazaki Y, Wakamiya A, Shimamoto K, Ueda N, Nakajima K, Kataoka N, Wada M, Yamagata K, Ishibashi K, Miyamoto K, Nagase S, Aiba T, Miyamoto Y, Iwanaga Y, Kusano K. Clinical Predictors of Pacing Device Implantation in Implantable Cardiac Monitor Recipients for Unexplained Syncope. CJC Open 2022; 5:259-267. [PMID: 37124961 PMCID: PMC10140738 DOI: 10.1016/j.cjco.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Implantable cardiac monitors (ICMs) help investigate the cause of unexplained syncope, but the probability and predictors of needing a pacing device thereafter remain unclear. Methods We retrospectively analyzed the data of patients who received ICM insertion for unexplained syncope with suspected arrhythmic etiology. The data were obtained from a nationwide database obtained between April 1, 2012 and March 31, 2020. Multivariable mixed-effects survival analysis was performed to identify predictors of pacing device implantation (PDI), and a risk score model was developed accordingly. Results In total, 2905 patients (age: 72 years [range: 60-78]) implanted with ICMs to investigate the cause of syncope were analyzed. During the median follow-up period of 128 days (range: 68-209) days, 473 patients (16%) underwent PDI. Older age, history of atrial fibrillation, bundle branch block (BBB), and diabetes were independent predictors of PDI in multivariable analysis. A risk score model was developed with scores ranging from 0 to 32 points. When patients with the lowest quartile score (0-13 points) were used as a reference, those with higher quartiles had a higher risk of PDI (second quartile: 14-15 points, hazard ratio [HR]: 3.86, 95% confidence interval [CI]: 2.62-5.68; third quartile: 16-18 points, HR: 4.67, 95% CI: 3.14-6.94; fourth quartile: 19-32 points, HR: 6.59, 95% CI: 4.47-9.71). Conclusions The 4 identified predictors are easily assessed during the initial evaluation of patients with syncope. They may help identify patients with a higher risk of requiring permanent PDI.
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Matsumoto K, Kodama Y, Ito S, Nakamura Y, Fujiwara R, Kajio K, Kasamatsu K, Murata E, Nakamura Y, Kawase Y. Clinical predictors of cardiac syncope in patients with unexplained syncope after the implantation of an insertable cardiac monitor. Heart Vessels 2022; 38:731-739. [PMID: 36443457 DOI: 10.1007/s00380-022-02212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Syncope prognosis is related to both its etiology and comorbidities, with cardiac syncope (CS) having higher risks for mortality and cardiovascular events than syncope of non-cardiac causes. Although a novel insertable cardiac monitor (ICM) is an effective diagnostic tool for unexplained syncope, decision regarding ICM implantation with a high pre-test likelihood of CS should contribute to economic cost reduction and avoidance of unnecessary complications. This study aimed to investigate clinical factors associated with CS after ICM implantation in patients with unexplained syncope. This retrospective observational study included 31 consecutive patients with ICM implantation for syncope between September 2016 and August 2021. The initial examinations for syncope included a detailed history, physical examination, blood tests, 12-lead electrocardiograms, and transthoracic echocardiography. Of the 31 patients, 13 (41.9%) experienced recurrent CS during follow-up (676 ± 469 days). Among several clinical factors, syncope-related minor injuries (p = 0.017) and higher brain natriuretic peptide (BNP; p = 0.043) levels were significantly associated with CS. Moreover, multivariable analysis showed that both syncope-related minor injuries (odds ratio, 11.2; 95% confidence interval, 1.4-88.4; p = 0.022) and BNP higher than 64.0 pg/mL (odds ratio, 7.0; 95% confidence interval, 1.1-44.2; p = 0.038) were independent predictors of CS after ICM implantation. In conclusion, a history of minor injury secondary to syncope and higher BNP levels were independent CS predictors in patients receiving ICM for syncope. These results emphasized the utility of ICM implantation early in the diagnostic journey of patients presenting with CS predictors requiring specific treatments.
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Affiliation(s)
- Kenji Matsumoto
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan.
| | - Yuka Kodama
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Shinji Ito
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yuka Nakamura
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Ryosuke Fujiwara
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Keiko Kajio
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Keiko Kasamatsu
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Eriko Murata
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yasuhiro Nakamura
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
| | - Yoshio Kawase
- Department of Cardiology, Izumi City General Hospital, 4-5-1 Wake-Cho, Izumi, 594-0073, Japan
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Xiao X, William J, Kistler PM, Joseph S, Patel HC, Vaddadi G, Kalman JM, Mariani JA, Voskoboinik A. Prediction of Pacemaker Requirement in Patients With Unexplained Syncope: The DROP Score. Heart Lung Circ 2022; 31:999-1005. [PMID: 35370087 DOI: 10.1016/j.hlc.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/18/2022] [Accepted: 03/04/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Implantable loop recorders (ILR) are increasingly utilised in the evaluation of unexplained syncope. However, they are expensive and do not protect against future syncope. OBJECTIVES To compare patients requiring permanent pacemaker (PPM) implantation during ILR follow-up with those without abnormalities detected on ILR in order to identify potential predictors of benefit from upfront pacing. METHODS We analysed 100 consecutive patients receiving ILR: Group 1 (n=50) underwent PPM insertion due to bradyarrhythmias detected on ILR; Group 2 (n=50) had no arrhythmias detected on ILR over >3 years follow-up. Baseline clinical characteristics, syncope history, electrocardiographic and echocardiographic parameters were assessed to identify predictors of ultimate requirement for pacing. RESULTS Group 1 (64% male, median age 70.8 years; IQR 65.5-78.8) were older than Group 2 (58% male, median 60.2 years; IQR 44.0-73.0 p=0.001) and were less likely to have related historical factors such as overheating, posture and exercise (98% vs 70% p<0.001). PR interval was also longer in Group 1 (192±51 vs 169±23 p=0.006) with greater prevalence of distal conduction system disease (30% vs 4.3% p=0.002). Significant univariate predictors for PPM insertion were distal conduction disease (p=0.007), first degree atrioventricular (AV) block (p=0.003), absence of precipitating factors (p=0.004), and age >65 years (p=0.001). Injury sustained, recurrent syncope, history of atrial fibrillation (AF) or heart failure, left atrial (LA) size and left ventricular ejection fraction (LVEF) were not predictive. These significant predictors were incorporated into the DROP score1 (0-4). Using time-to-event analysis, no patients with a score of 0 progressed to pacing, while higher scores (3-4) strongly predicted pacing requirement (log-rank p<0.001). CONCLUSION The DROP score may be helpful in identifying patients likely to benefit from upfront permanent pacemaker (PPM) insertion following unexplained syncope. Larger prospective studies are required to validate this tool.
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Affiliation(s)
- Xiaoman Xiao
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Jeremy William
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Peter M Kistler
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Health, Melbourne, Vic, Australia
| | - Stephen Joseph
- Department of Cardiology, Western Health, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Health, Melbourne, Vic, Australia
| | - Hitesh C Patel
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Gautam Vaddadi
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Health, Melbourne, Vic, Australia
| | - Jonathan M Kalman
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Justin A Mariani
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Health, Melbourne, Vic, Australia.
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Kreimer F, Aweimer A, Backhaus JF, Pflaumbaum A, Mügge A, Gotzmann M. Predictors for the detection of arrhythmia requiring pacemaker/ICD implantation ‐ Results from a loop recorder study. Pacing Clin Electrophysiol 2022; 45:1106-1114. [DOI: 10.1111/pace.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/10/2022] [Accepted: 04/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Fabienne Kreimer
- Cardiology and Rhythmology University Hospital St Josef‐Hospital Bochum, Ruhr University Bochum Bochum Germany
| | - Assem Aweimer
- Cardiology University Hospital Bergmannsheil Bochum, Ruhr University Bochum Bochum Germany
| | - Julian Felix Backhaus
- Cardiology and Rhythmology University Hospital St Josef‐Hospital Bochum, Ruhr University Bochum Bochum Germany
| | - Andreas Pflaumbaum
- Cardiology and Rhythmology University Hospital St Josef‐Hospital Bochum, Ruhr University Bochum Bochum Germany
| | - Andreas Mügge
- Cardiology and Rhythmology University Hospital St Josef‐Hospital Bochum, Ruhr University Bochum Bochum Germany
| | - Michael Gotzmann
- Cardiology and Rhythmology University Hospital St Josef‐Hospital Bochum, Ruhr University Bochum Bochum Germany
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11
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Francisco-Pascual J, Rivas-Gándara N, Bach-Oller M, Badia-Molins C, Maymi-Ballesteros M, Benito B, Pérez-Rodon J, Santos-Ortega A, Sambola-Ayala A, Roca-Luque I, Cantalapiedra-Romero J, Rodríguez-Silva J, Pascual-González G, Moya-Mitjans À, Ferreira-González I. Sex-Related Differences in Patients With Unexplained Syncope and Bundle Branch Block: Lower Risk of AV Block and Lesser Need for Cardiac Pacing in Women. Front Cardiovasc Med 2022; 9:838473. [PMID: 35282384 PMCID: PMC8914040 DOI: 10.3389/fcvm.2022.838473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To analyze if there are sex-related differences in patients with unexplained syncope and bundle branch block (BBB). Background Despite increasing awareness that sex is a major determinant of the incidence, etiology, and the outcomes of different arrhythmias, no studies have examined differences in presentation and outcomes between men and women with syncope and BBB. Methods Cohort study of consecutive patients with unexplained syncope and BBB was included from January 2010 to January 2021 with a median follow-up time of 3.4 years [interquartile range (IQR) 1.7–6.0 years]. They were evaluated by a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor (ICM). Results Of the 443 patients included in the study, 165 (37.2%) were women. Compared with men, women had less diabetes (25.5 vs. 39.9%, p = 0.002) and less history of ischemic heart disease (IHD; 13.3 vs. 25.9%, p = 0.002). Left bundle branch block (LBBB) was more frequent in women (55.2 vs. 27.7%, p < 0.001) while right bundle branch block (RBBB) was more frequent in men (41.5 vs. 67.7%, p < 0.001). His to ventricle (HV) interval in the EPS was shorter in women (58 ms [IQR 52–71] vs. 60 ms [IQR 52–73], p = 0.035) and less women had an HV interval longer than 70 ms (28.5 vs. 38.1%, p = 0.039), however, EPS and ICM offered a similar diagnostic yield in both sexes (40.6 vs. 48.9% and 48.4% vs. 51.1%, respectively). Women had a lower risk of developing atrioventricular block (AVB) (adjusted odds ratio [OR] 0.44–95% CI 0.26–0.74, p = 0.002) and of requiring permanent pacemaker implantation (adjusted hazard ratio [HR] 0.72–95% CI: 0.52–0.99, p = 0.046). The mortality rate was lower in women (4.5 per 100 person-years [95% CI 3.1–6.4 per 100 person-years] vs. 7.3 per 100 person-years [95% CI 5.9–9.1 per 100 person-years]). Conclusions Compared to men, women with unexplained syncope and BBB have a lower risk of AVB and of requiring cardiac pacing. A stepwise diagnostic approach has a similar diagnostic yield in both sexes, and it seems appropriate to guide the treatment and avoid unnecessary pacemaker implantation, especially in women.
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Affiliation(s)
- Jaume Francisco-Pascual
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Bach-Oller
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Badia-Molins
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Maymi-Ballesteros
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Begoña Benito
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonia Sambola-Ayala
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Arrhythmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Javier Cantalapiedra-Romero
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Silva
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Gabriel Pascual-González
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Àngel Moya-Mitjans
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Cardiology Department, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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12
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Radovanović NN, Pavlović SU, Kirćanski B, Branković N, Vujadinović N, Sajić V, Milašinović A, Bisenić V, Živković M, Milašinović G. Diagnostic value of implantable loop recorders in patients with unexplained syncope or palpitations. Ann Noninvasive Electrocardiol 2021; 26:e12864. [PMID: 34097780 PMCID: PMC8411757 DOI: 10.1111/anec.12864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/23/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background The implantable loop recorder (ILR) is a small cardiac rhythm‐monitoring device. Our aim was to determine ILR diagnostic value in patients with unexplained syncope, presyncope, or palpitations suggesting cardiac arrhythmias. Methods This has been a retrospective, observational, single‐center study. We included 181 patients in whom ILR was implanted at the Clinical Center of Serbia between January 2006 and July 2019. An event was marked as diagnostic if it led to a diagnosis and ILR was considered diagnostic if it verified or excluded an arrhythmia as the cause of syncope or palpitations. Results The mean age was 51.8 ± 17.8 years and 94 (51.9%) were male. The mean follow‐up period was 20.2 ± 15.8 months. ILR was diagnostic in 98 patients (54.1%). There was no significant difference in diagnostic value of ILR in regard to the baseline patients’ characteristics. The mean time to occurrence of the diagnostic event was 11.1 ± 9.6 months. The time to occurrence of a diagnostic event did not differ significantly between patients who underwent basic as compared to extended diagnostics before ILR implantation. Conclusions ILR was able to achieve an etiological diagnosis in 54.1% of patients with unexplained syncope, presyncope, or palpitations suggesting cardiac arrhythmias. In a subgroup of patients with recurrent palpitations, ILR was significantly less diagnostic than in patients with syncope or presyncope. ILR should be implanted beforehand in syncope evaluation process.
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Affiliation(s)
| | - Siniša U Pavlović
- Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bratislav Kirćanski
- Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Vojislav Sajić
- Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Milašinović
- Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Vesna Bisenić
- Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Goran Milašinović
- Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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13
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Onuki T, Shoji M, Sugiyama H, Arai S, Yoshikawa K, Mase H, Kurata M, Kikuchi M, Wakatsuki D, Asano T, Suzuki H, Tanno K, Kobayashi Y, Shinke T. Clinical predictors for bradycardia and supraventricular tachycardia necessitating therapy in patients with unexplained syncope monitored by insertable cardiac monitor. Clin Cardiol 2021; 44:683-691. [PMID: 33724499 PMCID: PMC8119800 DOI: 10.1002/clc.23594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) improve diagnostic yield in patients with unexplained syncope. The most of cardiac syncope is arrhythmic causes include paroxysmal bradycardia and supraventricular tachycardia (SVT) in patients with unexplained syncope receiving ICM. Predictors for bradycardia and SVT that necessitate therapy in patients with unexplained syncope are not well known. Hypothesis This study aimed to investigate predictors of bradycardia and SVT necessitating therapy in patients with unexplained syncope receiving ICMs. Methods We retrospectively reviewed medical records of consecutive patients who received ICMs to monitor unexplained syncope. We performed Cox's stepwise logistic regression analysis to identify significant independent predictors for bradycardia and SVT. Results One hundred thirty‐two patients received ICMs to monitor unexplained syncope. During the 17‐month follow‐up period, 19 patients (14%) needed pacemaker therapy for bradycardia; 8 patients (6%) received catheter ablation for SVT. The total estimated diagnostic rates were 34% and 48% at 1 and 2 years, respectively. Stepwise logistic regression analysis indicated that syncope during effort (odds ratio [OR] = 3.41; 95% confidence interval [CI], 1.21 to 9.6; p = .02) was an independent predictor for bradycardia. Palpitation before syncope (OR = 9.46; 95% CI, 1.78 to 50.10; p = .008) and history of atrial fibrillation (OR = 10.1; 95% CI, 1.96 to 52.45; p = .006) were identified as significant independent predictors for SVT. Conclusion Syncope during effort, and palpitations or history of atrial fibrillation were independent predictors for bradycardia and for SVT. ICMs are useful devices for diagnosing unexplained syncope.
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Affiliation(s)
- Tatsuya Onuki
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
| | - Makoto Shoji
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
| | - Hiroto Sugiyama
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
| | - Shuhei Arai
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
| | - Kosuke Yoshikawa
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
| | - Hiroshi Mase
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Masaaki Kurata
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Miwa Kikuchi
- Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Daisuke Wakatsuki
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Taku Asano
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Kaoru Tanno
- Cardiovascular Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Youichi Kobayashi
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
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14
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Doundoulakis I, Gatzoulis KA, Arsenos P, Dilaveris P, Skiadas I, Tsiachris D, Antoniou C, Soulaidopoulos S, Karystinos G, Pylarinou V, Drakopoulou M, Sideris S, Vlachopoulos C, Tousoulis D. Permanent pacemaker implantation in unexplained syncope patients with borderline sinus bradycardia and electrophysiology study-proven sinus node disease. J Arrhythm 2021; 37:189-195. [PMID: 33664902 PMCID: PMC7896452 DOI: 10.1002/joa3.12460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Significant sinus bradycardia (SB) in the context of sinus node dysfunction (SND) has been associated with neurological symptoms. The objective was to evaluate the effect of permanent pacing on the incidence of syncope in patients with rather mild degrees of SB, unexplained syncope, and "positive" invasive electrophysiologic testing. METHODS This was an observational study based on a prospective registry of 122 consecutive mild SB patients (61.90 ± 18.28 years, 61.5% male, 57.88 ± 7.73 bpm) presenting with recurrent unexplained pre and syncope attacks admitted to our hospital for invasive electrophysiology study (EPS). Τhe implantation of a permanent antibradycardia pacemaker (ABP) was offered to all patients according to the results of the EPS. Eighty patients received the ABP, while 42 denied. RESULTS The mean of reported syncope episodes was 2.23 ± 1.29 (or presyncope 2.36 ± 1.20) in the last 12 months before they were referred for a combined EP guided diagnostic and therapeutic approach. Over a mean follow-up of approximately 4 years (50.39 ± 32.40 months), the primary outcome event (syncope) occurred in 18 of 122 patients (14.8%), 6 of 80 (7.5%) in the ABP group as compared to 12 of 42 (28.6%) in the no pacemaker group (P = .002). CONCLUSIONS Among patients with mild degree of SB and a history of unexplained syncope, a set of positivity criteria for the presence of EPS defined SND after differentiating reflex syncope, identifies a subset of patients who will benefit from permanent pacing.
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Affiliation(s)
- Ioannis Doundoulakis
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Konstantinos A. Gatzoulis
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Petros Arsenos
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Polychronis Dilaveris
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Ioannis Skiadas
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | | | | | - Stergios Soulaidopoulos
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - George Karystinos
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Voula Pylarinou
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Maria Drakopoulou
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Skevos Sideris
- State Department of Cardiology“Hippokration” HospitalAthensGreece
| | - Charalambos Vlachopoulos
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
| | - Dimitrios Tousoulis
- First Department of CardiologyNational and Kapodistrian University“Hippokration” HospitalAthensGreece
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15
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Mitro P, Šimurda M, Lazúrová Z, Jakubová M. Etiology of syncope in patients with preexisting atrioventricular conduction disorders. Pacing Clin Electrophysiol 2020; 43:1268-1272. [PMID: 32901951 DOI: 10.1111/pace.14064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/26/2020] [Accepted: 09/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The discussion about the feasibility of empiric pacemaker implantation in patients with preexisting atrioventricular (AV) conduction disorders continues. The aim of the study was to determine the etiology of syncope and the need for pacemaker insertion in patients with AV conduction impairment using implantable loop recorder (ILR). METHODS ILR was implanted after negative diagnostic workup in 37 patients with syncope (24 men, 13 women, age 72 ± 10 years) and preexisting impairment of AV conduction. First-degree AV block (AVB I) was present in 26 patients, and bundle branch block (BBB) in 17 patients. RESULTS ILR-based diagnosis was made in 28 patients (75%)-sinus arrest in 13 patients, complete AVB in 10 patients, and vasodepressor syncope in five patients. In patients with preexisting BBB, sinus arrest occurred during ILR monitoring significantly more frequently than in patients without BBB (53% vs 20%, P = .03). Complete AVB was significantly less common in patients with preexisting BBB than in patients without BBB (12% vs 40%, P = .04). On multivariate regression analysis, the only independent predictor of AVB occurrence during ILR monitoring was preexisting AVB I (P = .03). The only independent predictor of sinus arrest during ILR monitoring was preexisting BBB (P = .03). CONCLUSIONS In patients with preexisting AV conduction disorders, prevailing syncopal mechanism during ILR monitoring was asystole. However, sinus arrest occurred more often than complete AVB and was predicted by preexisting BBB. Preexisting AVB was a predictor of complete AVB during ILR monitoring.
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Affiliation(s)
- Peter Mitro
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
| | - Miloš Šimurda
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
| | - Zora Lazúrová
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
| | - Marta Jakubová
- Cardiology Clinic, Safarik University, VUSCH, Košice, Slovakia
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16
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Huemer M, Becker AK, Wutzler A, Attanasio P, Parwani AS, Lacour P, Boldt LH, Pieske B, Haverkamp W, Blaschke F. Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation. Cardiol J 2018; 26:36-46. [PMID: 29399750 DOI: 10.5603/cj.a2018.0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/12/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplainedsyncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion. METHODS One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. RESULTS The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2-350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035). CONCLUSIONS Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation.
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Affiliation(s)
- Martin Huemer
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Ann-Kristin Becker
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Alexander Wutzler
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Philipp Attanasio
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Abdul S Parwani
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Philipp Lacour
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Florian Blaschke
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany.
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Kane AE, Howlett SE. Differences in Cardiovascular Aging in Men and Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:389-411. [PMID: 30051398 DOI: 10.1007/978-3-319-77932-4_25] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases increase dramatically with age in both men and women. While it is clear that advanced age allows more time for individuals to be exposed to risk factors in general, there is strong evidence that age itself is a major independent risk factor for cardiovascular disease. Indeed, there are distinct age-dependent cellular, structural, and functional changes in both the heart and blood vessels, even in individuals with no clinical evidence of cardiovascular disease. Studies in older humans and in animal models of aging indicate that this age-related remodeling is maladaptive. An emerging view is that the heart and blood vessels accumulate cellular and subcellular deficits with age and these deficits increase susceptibility to disease in older individuals. Aspects of this age-dependent remodeling of the heart and blood vessels differ between the sexes. There is also new evidence that these maladaptive changes are more prominent in older animals and humans with a high degree of frailty. These observations may help explain why men and women are susceptible to different cardiovascular diseases as they age and why frail older adults are most often affected by these diseases.
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Affiliation(s)
- Alice E Kane
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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Prochnau D, Lambert T, Sigusch H, Surber R, Schulze PC. Predictors of future arrhythmic events in patients with unexplained syncope. Acta Cardiol 2017; 72:530-535. [PMID: 28682147 DOI: 10.1080/00015385.2017.1306389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS The purpose of this study was to examine the usefulness of implantable loop recorders (ILRs) for symptom-rhythm correlation and to identify predictors of future arrhythmic events. PATIENTS AND METHODS In our dual-centre study, we analysed ILR data of 189 patients (mean age 67.4 ± 15.2 years, 114 male) with unexplained syncope (single syncope 21 patients, recurrent 168 patients, traumatic injury 43 patients). Patients had severe comorbidities such as hypertension (n = 127), coronary artery disease (n = 31), diabetes mellitus (n = 33) and chronic renal insufficiency (n = 18). The median ILR usage was 29 months (M), with a range between 1 and 46 M. RESULTS Forty-nine (26%) patients experienced syncope during the study, with a median of 8 M to first recurrence of syncope. In 43 patients, pacemaker implantation was performed because of sinus node disease (n = 29), high-degree AV-block (n = 6) or atrial fibrillation with slow ventricular rate (n = 8). In five patients, an ICD was implanted because of documented ventricular tachycardia (n = 4) or left ventricular ejection fraction <35% (n = 1). One patient received ablation of the cavotricuspid isthmus because of documented atrial flutter. Concerning the clinical course, in five patients explantation of the ILR was necessary due to pocket infection. Three patients died due to non-cardiac causes. Logistic regression analysis revealed that older patients had a significantly higher risk for future arrhythmic events (OR 1.3, p = .039). CONCLUSIONS ILR monitoring is effective in indicating causes of unexplained syncope by providing symptom-rhythm associations. Only age was a predictor of future arrhythmic events. The mortality in patients with unexplained syncope was very low.
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Affiliation(s)
- Dirk Prochnau
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
- Department of Cardiology, Catholic “St. Johann Nepomuk” Hospital, Erfurt, Germany
| | - Tobias Lambert
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Holger Sigusch
- Department of Cardiology, Heinrich-Braun-Hospital, Zwickau, Germany
| | - Ralf Surber
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
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19
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Mitro P, Šimurda M, Müller E. Clinical characteristics associated with bradycardia and asystole in patients with syncope undergoing long-term electrocardiographic monitoring with implantable loop recorder. Wien Klin Wochenschr 2017; 129:451-457. [DOI: 10.1007/s00508-017-1197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
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20
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Pentimalli F, Bacino L, Ghione M, Giambattista S, Gazzarata M, Bellotti P. Ajmaline Challenge To Unmask Infrahisian Disease In Patients With Recurrent And Unexplained Syncope, Preserved Ejection Fraction, With Or Without Conduction Abnormalities On Surface ECG. J Atr Fibrillation 2016; 9:1421. [PMID: 27909532 DOI: 10.4022/jafib.1421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022]
Abstract
Background: Pharmacological challenge with class I antiarrhythmic drug is a recommended diagnostic test in patients with unexplained syncope only in the presence of bundle branch block, when non-invasive tests have failed to make the diagnosis. Its role in patients with minor or no conduction disturbances on 12-leads ECG has not been evaluated yet. It is also not clear which are the values of His-Ventricular interval to be considered diagnostic. We sought to evaluate the role of ajmaline challenge in unmasking the presence of an infrahisian disease in patients with recurrent and unexplained syncope, regardless of the existence of conduction disturbances on surface ECG. Materials And Methods: Patients with history of recurrent syncope, preserved EF and a negative first level workup were enrolled. Conduction disturbances on ECG were not considered as an exclusion criteria. During EPS, basal HV conduction was determined. In the presence of a HV >70 msec the study was interrupted and the patient was implanted with a pacemaker. If the HV was ≤ 70 msec, ajmaline was infused and HV was reassessed. The maximum value of HV was considered. A prolongation ≥ 100 msec was considered as diagnostic and indicative of conduction disease, and the patient underwent pacemaker implantation. Patients with an HV <100 msec were implanted with an ILR. Results: Sixteen consecutive patients were studied (age 76±5.2 years). Nine patients had conduction disturbances at baseline ECG (group ECG+). Among them, 5 had a basal diagnostic HV interval and 4 had a non-diagnostic HV interval. In the latter group, abnormal response to ajmaline was observed in 3 patients. In this group only one patient was implanted with an ILR, 8 patients were implanted with a pacemaker. Among the seven patients without conduction disturbances (group ECG-), no one had a diagnostic basal HV interval. After drug administration, 4 patients had a non-diagnostic response and were implanted with an ILR, while 3 patient had a pathological response and were implanted with a pacemaker. No difference was found in the values of maximum HV interval prolongation after ajmaline between the two groups (P = 0.89). During a mean follow up of 13±3 months, no patient has developed a syncopal episode. One patient in group ECG- and negative drug test was implanted after 3 months with a permanent pacemaker because of a two to one asymptomatic AV block at ILR interrogation. Conclusions: Ajmaline challenge is a useful tool to unmask the presence of a infrahisian disease in patients with preserved EF, unexplained syncope and negative workup, even in the absence of conduction disturbances on 12-leads ECG. It is a simple and safe test that may disclose the detection of the disease. In these patients, an earlier pacemaker implantation of a pacemaker, may avoid the consequences of a syncopal recurrence. Values of HV interval > 70 msec in basal conditions and ≥ 100 msec after ajmaline administration seem appropriate to unmask infrahisian disease. Larger population is required to validate this hypothesis.
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Affiliation(s)
| | - Luca Bacino
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Matteo Ghione
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Siri Giambattista
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Massimo Gazzarata
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
| | - Paolo Bellotti
- EP Lab, S.C. Cardiologia/Unità Coronarica Ospedale S Paolo - ASL 2 Savonese
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Silveira I, Sousa MJ, Antunes N, Silva V, Roque C, Pinheiro-Vieira A, Lagarto V, Hipólito-Reis A, Luz A, Torres S. Efficacy And Safety Of Implantable Loop Recorder: Experience Of A Center. J Atr Fibrillation 2016; 9:1425. [PMID: 27909534 DOI: 10.4022/jafib.1425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/05/2016] [Accepted: 08/07/2016] [Indexed: 12/28/2022]
Abstract
Introduction: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. Methods: A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. Results: A total of 62 patients were included, 50% men, with a mean age of 62.5±18.8 years old. Previously to ILR implantation 88.7% of patients had performed Holter, 17.7% external events recorder, 33.9% Tilt test and 29% an electrophysiological study. The implantation indications were recurrent syncope in 90.3%, palpitations 8.1% and ischemic stroke in one patient. Mean follow-up time was 17.1±16.3 months. Symptoms were reported in 66.1% of the patients, 46.8% of those yielding a diagnostic finding. In all cases of palpitation complaints with diagnosis we found atrial fibrillation (AF). In patients with syncope atrioventricular conduction disturbance was demonstrated in 19.6%, sinus node dysfunction in 16.1%, paroxysmal supra-ventricular tachycardia 7.1% and AF in 1.8%. These finding resulted in 19 pacemaker and one CRT-D implantation, introduction of anticoagulation in five patients and one ablation of accessory pathway. There were no major complications. Conclusion: ILR proved to be safe and efficient. It has enabled the identification or exclusion of serious rhythm disturbances in more than half of patients and provided a targeted therapeutic intervention.
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Affiliation(s)
- Inês Silveira
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Maria João Sousa
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Nuno Antunes
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Vânia Silva
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Carla Roque
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | | | - Vítor Lagarto
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | | | - André Luz
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Severo Torres
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
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22
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Silveira I, Sousa MJ, Antunes N, Silva V, Roque C, Pinheiro-Vieira A, Lagarto V, Hipólito-Reis A, Luz A, Torres S. Efficacy And Safety Of Implantable Loop Recorder: Experience Of A Center. J Atr Fibrillation 2016. [PMID: 27909534 DOI: 10.4022/jafib.1425.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. Methods: A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. Results: A total of 62 patients were included, 50% men, with a mean age of 62.5±18.8 years old. Previously to ILR implantation 88.7% of patients had performed Holter, 17.7% external events recorder, 33.9% Tilt test and 29% an electrophysiological study. The implantation indications were recurrent syncope in 90.3%, palpitations 8.1% and ischemic stroke in one patient. Mean follow-up time was 17.1±16.3 months. Symptoms were reported in 66.1% of the patients, 46.8% of those yielding a diagnostic finding. In all cases of palpitation complaints with diagnosis we found atrial fibrillation (AF). In patients with syncope atrioventricular conduction disturbance was demonstrated in 19.6%, sinus node dysfunction in 16.1%, paroxysmal supra-ventricular tachycardia 7.1% and AF in 1.8%. These finding resulted in 19 pacemaker and one CRT-D implantation, introduction of anticoagulation in five patients and one ablation of accessory pathway. There were no major complications. Conclusion: ILR proved to be safe and efficient. It has enabled the identification or exclusion of serious rhythm disturbances in more than half of patients and provided a targeted therapeutic intervention.
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Affiliation(s)
- Inês Silveira
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Maria João Sousa
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Nuno Antunes
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Vânia Silva
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Carla Roque
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | | | - Vítor Lagarto
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | | | - André Luz
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
| | - Severo Torres
- Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal
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23
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Cheung CC, Krahn AD. Loop recorders for syncope evaluation: what is the evidence? Expert Rev Med Devices 2016; 13:1021-1027. [DOI: 10.1080/17434440.2016.1243463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yang P, Pu L, Yang L, Li F, Luo Z, Guo T, Hua B, Li S. Value of Implantable Loop Recorders in Monitoring Efficacy of Radiofrequency Catheter Ablation in Atrial Fibrillation. Med Sci Monit 2016; 22:2846-51. [PMID: 27518153 PMCID: PMC4993216 DOI: 10.12659/msm.897333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/08/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the value of the implantable loop recorder (ILR) in diagnosing atrial fibrillation (AF) and assessing the postoperative efficacy of radiofrequency catheter ablation (RFCA). MATERIAL AND METHODS A total of 32 patients who successfully underwent RFCA were selected. These patients discontinued antiarrhythmic medication with no AF recurrence for more than 3 months after RFCA, and underwent ILR placement by a conventional method. The clinical manifestations and information on arrhythmias recorded by the ILR were followed up to assess the efficacy of AF RFCA. RESULTS The mean follow-up period was 24.7±12.5 months. Of 32 patients with ILR information, 27 had successful RFCA and 5 had recurrent AF. The follow-up results obtained by traditional methods showed 29 patients with successful RFCA and 3 with recurrent AF (P<0.05). Among the 18 patients with clinical symptoms, 13 had recorded cardiac arrhythmic events (72.2%) and 5 showed sinus rhythm (27.8%). The ILRs recorded 18 patients with arrhythmic events (56.3%), including 12 cases of atrial arrhythmias, among whom 5 recurred at 9, 12, 16, 17, and 32 months after AF RFCA; there were also 2 patients with ventricular tachycardia (VT) and 4 with bradycardia. CONCLUSIONS The value of ILR in assessing the efficacy of AF RFCA was superior to that of traditional methods. ILR can promptly detect asymptomatic AF, and can monitor electrocardiogram features after RFCA, thus providing objective evidence of efficacy.
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Affiliation(s)
- Ping Yang
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Lijin Pu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Liuqing Yang
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, U.S.A
| | - Fang Li
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Zhiling Luo
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Tao Guo
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Baotong Hua
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Shumin Li
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
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25
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Lee AKY, Krahn AD. Evaluation of syncope: focus on diagnosis and treatment of neurally mediated syncope. Expert Rev Cardiovasc Ther 2016; 14:725-36. [DOI: 10.1586/14779072.2016.1164034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Selección de temas de actualidad en arritmias y estimulación cardiaca 2015. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Peinado R, Ruiz-Mateas F, Izquierdo M, Arana E, Robledo M, Arias MA, Jiménez-Jáimez J, Rodríguez-Mañero M, Chimeno J. Cardiac Arrhythmias and Pacing 2015: A Selection of Topical Issues. ACTA ACUST UNITED AC 2016; 69:167-75. [PMID: 26778594 DOI: 10.1016/j.rec.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Rafael Peinado
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Maite Izquierdo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eduardo Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Maria Robledo
- Sección de Arritmias, Servicio de Cardiología, Hospital Universitario Araba, Vitoria, Álava, Spain
| | - Miguel Angel Arias
- Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Juan Jiménez-Jáimez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Moisés Rodríguez-Mañero
- Unidad de Arritmias, Departamento de Cardiología, Complejo Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Javier Chimeno
- Sección de Cardiología, Hospital Virgen de la Concha, Zamora, Spain
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