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Cited by 37Cardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmiasVestibular and auditory disorders

Additional diagnostic value of implantable loop recorder in patients with initial diagnosis of real or apparent transient loss of consciousness of uncertain origin

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Maggi, R., Rafanelli, M., Ceccofiglio, A., Solari, D., Brignole, M., Ungar, A.·2014·Europace
DOI 10.1093/europace/euu051
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Abstract

AIMS: Non-syncopal transient loss of consciousness (T-LOC) encompasses disorders that sometimes resemble syncope, and the differential diagnosis with true syncope may be challenging. The implantable loop recorder (ILR) is potentially useful, but has never been systematically assessed. The aim of the study is to evaluate the diagnostic value of ILR in distinguishing syncope from non-syncopal forms of T-LOC. METHODS AND RESULTS: We implanted an ILR in 58 patients (mean age 71 ± 17 years, 25 males) who had had 4.6 ± 2.3 episodes of real or apparent T-LOC, in order to distinguishing epilepsy from syncope (#28), unexplained fall from syncope (#29), or functional pseudo-syncope from syncope (#1). During 20 ± 13 months of follow-up, 33 patients (57%) had a spontaneous event documented by ILR. A diagnosis of syncope was established by ILR documentation of an arrhythmia in 15 (26%) patients: an asystole of 6 s (IQR 4-10 s) duration was documented at the time of the spontaneous event in seven patients with initial suspicion of epilepsy and in five patients with unexplained fall; atrial tachyarrhythmia was documented at the time of the spontaneous event in 1 and 1 patient, respectively, and ventricular tachycardia in 1 patient with unexplained fall. Conversely, in another 18 patients, ILR monitoring documented no significant rhythm abnormalities at the time of T-LOC recurrence, thus excluding an arrhythmic syncope. Finally, ILR was unable to document any syncopal episode in 25 (43%) patients. Among the 15 patients with an established diagnosis of arrhythmic syncope, syncope recurred during follow-up in 2 of 11 patients who were on pacemaker therapy and in 3 of 4 patients who were on other therapies. CONCLUSION: Implantable loop recorder monitoring provides additional diagnostic value in 'difficult' patients with an initial diagnosis of non-syncopal real or apparent T-LOC.

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  • In patients in whom epilepsy was suspected but the treatment has proven ineffective, an attack could have been documented by ILR in 62% of patients, with an arrhythmic cause being responsible in 26%.

    “Patients in whom epilepsy was suspected but the treatment has proven ineffective: in pooled data, an attack could have been documented by ILR in 62% of patients, with an arrhythmic cause being responsible in 26% 137,189-191”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [191]

    Table 2 (page unavailable) pools ILR results for suspected epilepsy and reports documented attacks in 91/145 patients (63%) and arrhythmias in 38/155 (25%), close to but not the claimed 62% and 26%. The Epilepsy vs. syncope section mentions patients treated with antiepileptic drugs, but does not establish ineffective treatment as a criterion for the pooled group. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • 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 [191]

    In “Unexplained fall vs. syncope” (page not available), the paper says ILR documented episodes in a similarly high percentage across studies, supporting the general point about attack documentation. It does not give the claimed pooled 70% and 14% figures in the available passages; for its own patients with unexplained falls, it reports arrhythmia documentation in 24%. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Authors
Maggi, R., Rafanelli, M., Ceccofiglio, A., Solari, D., Brignole, M., & Ungar, A.
Affiliations
Azienda Ospedaliero-Universitaria Careggi (IT)
Corresponding author
Maggi, R.
ORCID
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2014-03-25
Volume
16
Issue
8
Pages
1226-1230
ISSN
  • 1099-5129 (ISSN-L)
  • 1532-2092
DOI
10.1093/europace/euu051
OpenAlex
W2002835466
Cited by
37
References
32
Citations by year
2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 6 · 2017: 6 · 2016: 2 · 2015: 2 · 2014: 3
FWCI
4.30
Type
journal article
Language
en
Open access
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
  • Florence Research (University of Florence) (submittedVersion)
  • INFM-OAR (INFN Catania) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Keywords
implantable loop recorder, transient loss of consciousness, syncope, arrhythmic syncope, epilepsy, unexplained falls, asystole, cardiac arrhythmias, syncope recurrence, pacemaker therapy
MeSH terms
Accidental Falls, Aged, Aged, 80 and over, Anticonvulsants, Arrhythmias, Cardiac, Cardiac Pacing, Artificial, Diagnosis, Differential, Epilepsy, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Syncope, Telemetry, Time Factors, Unconsciousness, Electrocardiography, Ambulatory, Treatment Outcome

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