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Cited by 76Cardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmiasHeart Rate Variability and Autonomic Control

Utility of Implantable Loop Recorder (Reveal Plus®) in the Diagnosis of Unexplained Syncope

Open access
LOMBARDI, F, CALOSSO, E, MASCIOLI, G, MARANGONI, E, DONATO, A, ROSSI, S, PALA, M, FOTI, F +1 more·2005·Europace
DOI 10.1016/j.eupc.2004.09.003
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Abstract

AIMS: In about 30% of patients with syncope, the responsible mechanisms remain unrecognised. Nevertheless, the possibility of an arrhythmic aetiology remains, however, difficult to rule out. METHODS: We therefore monitored with an implantable loop recorder (ILR, Reveal Plus, Medtronic) 34 subjects (60+/-15 years) with at least two unexplained syncopal episodes and negative neurological and cardiovascular work-up. RESULTS: During a follow-up of 7+/-4 months, syncope occurred in 11 subjects. In nine of them the mechanisms responsible for these events were identified by ILR monitoring: marked bradycardia or asystole (n=6), atrial fibrillation with wide QRS tachycardia (n=1) and sinus rhythm with fine artifacts likely to be due to muscle contractions (n=2). Pre-syncope occurred in seven patients: advanced atrioventricular block (n=3), sinus tachycardia (n=1), and wide QRS tachycardia (n=1) were documented. Thus, when considering all 18 patients with recurrences, a diagnosis was achieved in 53% of subjects. Recognition of the rhythm disorder in seven patients with syncope and four patients with pre-syncope guided patient management. CONCLUSIONS: These data indicate that ILR monitoring facilitates the identification of mechanisms responsible for recurrences and therapeutic management in subjects with syncope or pre-syncope and negative traditional neurological and cardiovascular work-up.

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Crossref · 10.1016/j.eupc.2004.09.003

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  • The ILR provided a high diagnostic yield in terms of cardiac arrhythmias in patients with syncope, not restricted to arrhythmias directly related to syncope.

    “Hence, the ILR provided a high diagnostic yield in terms of cardiac arrhythmias in patients with syncope, not restricted to arrhythmias directly related to syncope [12,13,14,15,17,19,35,36] but including other diagnoses with therapeutic implications such as atrial fibrillation.”

    From Diagnostic Yield and Clinical Implications of Implantable Loop Recorders in Patients with Syncope in Germany: A National Database Analysis (2024) · cites this paper as [12]

    The Pre-syncopal events section reports that ILR monitoring detected a rhythm disturbance in 13 patients and achieved a diagnosis in 18 of 20 patients with syncopal or pre-syncopal events, supporting a high diagnostic yield in patients with recurrences. The reported arrhythmias are tied to those events; our copy does not establish a high yield for arrhythmias unrelated to syncope or pre-syncope. The Syncopal episodes section records atrial fibrillation during a syncopal episode, not as an unrelated finding. Page numbers are unavailable in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The clinical picture of syncope frequently includes neurological symptoms and is often mistaken for epilepsy, which probably explains why neurologists are frequently consulted.

    “The clinical picture of syncope frequently includes neurological symptoms and is often mistaken for epilepsy,18 which probably explains why neurologists are frequently consulted.”

    From Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry (2011) · cites this paper as [18]

    The Introduction (page not available) says epileptic seizures can be difficult to rule out in young people with transient loss of consciousness, and the Discussion says seizures are considered when some syncopal episodes are hard to interpret. This supports diagnostic confusion with epilepsy, but the paper does not establish that syncope frequently includes neurological symptoms or is often mistaken for epilepsy. The statement about why neurologists are consulted is the citing authors’ inference, not part of the claim supported by this citation. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • ILR are used to confirm the etiology of syncope.

    “Next to noninvasive monitoring strategies, implantable loop recorders (ILR) are used to confirm the etiology of syncope [2,12,13,14,15,16,17,18]”

    From Diagnostic Yield and Clinical Implications of Implantable Loop Recorders in Patients with Syncope in Germany: A National Database Analysis (2024) · cites this paper as [12]

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Research works printed but not linked: 1

  1. [2]2. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical practice: implementation of a simplified diagnostic algorithm in a multicenter prospective trial. The OESIL study. Eur Heart J 2000;21:935e40.

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Authors
LOMBARDI, F., CALOSSO, E., MASCIOLI, G., MARANGONI, E., DONATO, A., ROSSI, S., PALA, M., FOTI, F., & LUNATI, M.
Affiliations
  • University of Milan (IT)
  • Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
  • Ospedale Maggiore di Lodi (IT)
  • Medtronic (Italy) (IT)
  • Azienda Ospedaliera Ospedale San Carlo Borromeo (IT)
  • ASST Melegnano e della Martesana (IT)
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
Corresponding author
LOMBARDI, F
ORCID
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2005-01
Volume
7
Issue
1
Pages
19-24
ISSN
1099-5129 (ISSN-L)
DOI
10.1016/j.eupc.2004.09.003
OpenAlex
W2103766542
Cited by
76
References
21
Citations by year
2026: 1 · 2024: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 10 · 2016: 2 · 2015: 2 · 2014: 10 · 2013: 4 · 2012: 3
FWCI
3.17
Type
journal article
Language
en
Open access
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
unexplained syncope, implantable loop recorder, arrhythmic syncope, presyncope, bradycardia, asystole, atrial fibrillation, wide QRS tachycardia, atrioventricular block, syncope diagnosis, cardiac rhythm monitoring
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prospective Studies, Syncope, Electrocardiography, Ambulatory, Chi-Square Distribution

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