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ISSN 0188-2198 (Print)

2009, Number 1

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Rev Mex Cardiol 2009; 20 (1)

Usefulness of subcutaneous implantable loop recorder (Reveal plus®), in the evaluation of patients with recurrent unknown syncope

Aguilar JA, Moya Á, Alonso C

Language: Spanish
References: 33
Page: 4-11
PDF size: 247.99 Kb.


ABSTRACT

Introduction: In about 38% of patients with syncope, the responsible mechanisms remain unrecognized. The aim of this study was to evaluate the usefulness of the implantable loop recorder for the diagnosis of recurrent syncope of unknown etiology. Patients and methods: We therefore monitored with an implantable loop recorder (Reveal Plus, Medtronic) Ninety patients with unexplained syncopal episodes and negative neurological and cardiovascular work-up, from February 2001 to March 2007. Results: Ninety patients (48 women, 42 men) aged ranged from 14 to 84 years (mean 60.4 years) received the implantable loop recorder. Twelve patients had coronary artery disease. Twenty-one had hypertensive cardiopathy; 2 patients had mild aortic valvulopathy, 5 patients had mild mitral valvulopathy. During follow up after implant, 16.4 months, 43 patients showed recurrence of symptoms concordant with prior episodes (time 100 ± 30 days). The syncope occurred in 35 subjects. In all cases, a diagnosis with documented arrhythmia was achieved: marked bradycardia or asystole (n = 19), paroxysmal atrial fibrillation (n = 7), paroxysmal supraventricular tachycardia (n = 5) and sustained ventricular tachycardia (n = 4). Presyncope occurred in 8 patients; bradycardia or systole (n = 4); paroxysmal atrial fibrillation (n = 1), paroxysmal supraventricular tachycardia (n = 2) and 1 patient diagnosis was not possible. All arrhythmias were treated successfully by pacemaker or ICD implantation, radiofrequency catheter ablation and/or medications. There were no complications related to the use of the device. Conclusions: These data indicate that implantable loop recorder monitoring facilitates the identification of mechanisms responsible for recurrences and therapeutic management in subjects with syncope or presyncope and negative traditional neurological and cardiovascular work-up.


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