Utility of in-hospital cardiac remote telemetry in patients with unexplained syncope
Open accessAbstract
AIMS: Cardiac remote telemetry (CR-TEL) is in wide use in cardiac units, but its diagnostic value in the setting of unexplained syncope is unknown. METHODS: One hundred and two consecutive patients (73 +/- 14 years) arriving to the emergency department due to an unexplained syncope were admitted under CR-TEL. Heart rhythm was continuously monitored from a central station by trained nurses. Events included all causes of mortality and arrhythmias unnoticed on emergency department. RESULTS: Thirty patients (29.4%) presented events. There were no deaths during the time of monitoring (4.8 +/- 2.7 days). Events requiring transfer to the coronary care units (CCU) occurred in 15 patients (14.7%), principally due to AV-block and extreme bradycardia. Cardiac remote telemetry was diagnostic in 18 patients (17.6%) in whom the arrhythmic event occurred simultaneously with the syncopal episode. Multivariate analysis showed that age > or =86 years (P < 0.01) and heart failure on admission (P < 0.04) were the strongest predictors of events. All transfers to the CCU were documented within the first 4 days. The best cut-off point as a threshold for CR-TEL monitoring time was 72 hours (sensitivity 73%, specificity 86%). CONCLUSION: Cardiac remote telemetry appears to be a useful tool in the management of patients with unexplained syncope, especially in those older and presenting heart failure on admission.
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The diagnostic yield of ECG monitoring varies from 1.9-17.6%.
“Although the diagnostic yield of ECG monitoring varies from 1.9-17.6%, 158-160 it is justified by the need to avoid immediate risk to the patient.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [159]
The ‘Cardiac remote telemetry in current clinical practice’ section says the diagnostic yield of ECG monitoring in patients with syncope may be low when an arrhythmic cause is not strongly suspected, and reports that nearly 18% of its patients were diagnosed with cardiac syncope. It does not give or substantiate the claimed 1.9–17.6% range. Page numbers are unavailable in our copy. (LLM, conf=0.82)
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2018 ESC Guidelines for the diagnosis and management of syncope
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
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- Authors
- Benezet-Mazuecos, J., Ibanez, B., Rubio, J. M., Navarro, F., Martin, E., Romero, J., & Farre, J.
- Affiliations
- Hospital Universitario Fundación Jiménez Díaz (ES)
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-10-03
- Volume
- 9
- Issue
- 12
- Pages
- 1196-1201
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2147247098
- Cited by
- 38
- References
- 24
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 5 · 2017: 8 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 3 · 2012: 2
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Surgery › Healthcare Technology and Patient Monitoring
- Keywords
- unexplained syncope, in-hospital monitoring, arrhythmia detection, heart failure, atrioventricular block, bradycardia, emergency department admission, elderly patients
- MeSH terms
- Aged, Aged, 80 and over, Arrhythmias, Cardiac, Coronary Care Units, Electrocardiography, Female, Heart Failure, Heart Rate, Humans, Male, Middle Aged, Prospective Studies, Syncope, Telemetry, Multivariate Analysis, Patient Selection, Endpoint Determination
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