The use of an implantable loop recorder in the investigation of unexplained syncope in older people
Open accessAbstract
INTRODUCTION: Reveal is a patient activated implantable loop recorder device with an 18 month battery life now available to assist in the diagnosis of suspected syncope or arrhythmias. We present our experience using this device in older subjects referred to a dedicated falls and syncope clinic in whom usual clinical assessment had not satisfactorily identified an attributable diagnosis but where we still suspected a cardiovascular cause for syncope or falls. METHODS AND RESULTS: during the past 3 years 15 subjects (mean age 73 years, range 61-89 years) had Reveal implanted for symptoms of syncope alone (n=6; 40%) and unexplained falls (n=3; 20%) or symptoms of syncope and unexplained falls (n=6; 40%). Symptom duration was long (mean 48 months; range 4-200 months). Subjects had experienced significant morbidity, 6 subjects (40%) required A&E attendance or hospital admission and 4 (27%) experienced a fracture. Despite extensive and repeated investigations, which included 12-lead ECG, echocardiogram, 24-h ambulatory heart rate monitor, 24-h ambulatory blood pressure monitor, orthostatic blood pressure measurement, supine and erect carotid sinus massage, electroencephalogram, and passive and GTN head up tilt testing, the attributable diagnosis remained unexplained. Of the 15 subjects, 7 have activated the device at 4 (range 0-14) months after implantation. Bradycardia was identified in 3 and ventricular tachycardia in 1 subject. Two subjects did not activate the device during the 18 months it was in-situ. Four people had problems with device activation. This is comparable to rates noted using Reveal in younger subjects. CONCLUSION: Reveal offers additional diagnostic yield in complex elderly subjects with suspected cardiovascular causes of syncope or unexplained falls which have not been previously satisfactorily diagnosed despite extensive investigations.
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In patients with unexplained falls, an attack could have been documented by ILR in 70% of patients, with an arrhythmic cause being responsible in 14%.
“Patients with unexplained falls: in pooled data, an attack could have been documented by ILR in 70% of patients, with an arrhythmic cause being responsible in 14% 191-194”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [192]
The Results report that 7 of 15 patients activated the ILR and 4 had recorded arrhythmias; the cohort included patients with unexplained falls, syncope, or both. This supports the paper's inclusion as a study in pooled data, but it does not itself report the pooled figures of 70% with a documented attack and 14% with an arrhythmic cause in patients with unexplained falls. (LLM, conf=0.85)
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The Consensus Committee of the American Autonomic Society and the American Academy of Neurology (1996) · Neurology · doi:10.1212/wnl.46.5.1470 · Cited by 1,238 · see citing works
Guidelines on management (diagnosis and treatment) of syncope
Brignole, M. (2001) · European Heart Journal · doi:10.1053/euhj.2001.2739 · Cited by 951 · see citing works
Evaluation and Outcome of Patients with Syncope
KAPOOR, W. N. (1990) · Medicine · doi:10.1097/00005792-199005000-00004 · Cited by 539 · see citing works
Use of an Extended Monitoring Strategy in Patients With Problematic Syncope
Krahn, A. D., Klein, G. J., Yee, R., Takle-Newhouse, T., & Norris, C. (1999) · Circulation · doi:10.1161/01.cir.99.3.406 · Cited by 360 · see citing works
McIntosh, S. J., Lawson, J., & Kenny, R. A. (1993) · The American Journal of Medicine · doi:10.1016/0002-9343(93)90261-m · Cited by 238 · see citing works
Kapoor, W. N., Snustad, D. G., Peterson, J. R., Wieand, H. S., Cha, R., & Karpf, M. (1986) · The American Journal of Medicine · doi:10.1016/0002-9343(86)90716-3 · Cited by 202 · see citing works
Kenny, R. A., O'Shea, D., & Parry, S. W. (2000) · Heart · doi:10.1136/heart.83.5.564 · Cited by 148 · see citing works
The overlap between syncope and falls in the elderly
Shaw, F. E., & Kenny, R. A. (1997) · Postgraduate Medical Journal · doi:10.1136/pgmj.73.864.635 · Cited by 137 · see citing works
Krahn, A. D., Klein, G. J., Yee, R., & Mandab, V. (1999) · American Heart Journal · doi:10.1016/s0002-8703(99)70411-4 · Cited by 95 · see citing works
Implantable loop recorder: evaluation of unexplained syncope
Kenny, R. A., & Krahn, A. D. (1999) · Heart · doi:10.1136/hrt.81.4.431 · Cited by 30 · see citing works
McIntosh, S. J., daCosta, D., Lawson, J. J., et al. (1992) · Age and Ageing · doi:10.1093/ageing/21.suppl_2.p13-b · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Linzer M, Yang EH, Estes M, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Ann Intern Med 1997; 127: 76-86.
- McIntosh S, DaCosta D, Kenny RA. Outcome of an integrated approach to the investigation of dizziness, falls and syncope. Age Ageing 1993; 22: 53-8.
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2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
Indications for the use of diagnostic implantable and external ECG loop recorders
Task Force members, Brignole, M., Vardas, P., Hoffman, E., Huikuri, H., Moya, A., Ricci, R., Sulke, N., Wieling, W., EHRA Scientific Documents Committee, et al. (2009) · Europace · doi:10.1093/europace/eup097 · Cited by 362 · see citing works
BRIGNOLE, M., MENOZZI, C., MAGGI, R., SOLANO, A., DONATEO, P., BOTTONI, N., LOLLI, G., QUARTIERI, F., CROCI, F., & ODDONE, D. (2005) · Europace · doi:10.1016/j.eupc.2005.02.116 · Cited by 76 · see citing works
Detection of asymptomatic arrhythmias in unexplained syncope
Krahn, A. D., Klein, G. J., Yee, R., & Skanes, A. C. (2004) · American Heart Journal · doi:10.1016/j.ahj.2004.01.024 · Cited by 76 · see citing works
Maggi, R., Rafanelli, M., Ceccofiglio, A., Solari, D., Brignole, M., & Ungar, A. (2014) · Europace · doi:10.1093/europace/euu051 · Cited by 37 · see citing works
Edvardsson, N., Garutti, C., Rieger, G., Linker, N. J., & for the PICTURE Study Investigators (2014) · Clinical Cardiology · doi:10.1002/clc.22300 · Cited by 28 · see citing works
- Authors
- Armstrong, V. L.
- Affiliations
- Royal Victoria Infirmary (GB)
- Corresponding author
- Armstrong, V. L.
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-03-01
- Volume
- 32
- Issue
- 2
- Pages
- 185-188
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W2153069563
- Cited by
- 47
- References
- 11
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 6 · 2016: 3 · 2015: 1 · 2014: 6 · 2013: 1 · 2012: 3
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- implantable loop recorder, syncope, unexplained falls, older adults, bradycardia, ventricular tachycardia, device activation, diagnostic yield
- MeSH terms
- Accidental Falls, Aged, Aged, 80 and over, Arrhythmias, Cardiac, Female, Humans, Male, Middle Aged, Syncope, Electrocardiography, Ambulatory
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