The DOI matches its Crossref record; 27 of the 27 references it cites were found in a registry or an index.
Use of an Extended Monitoring Strategy in Patients With Problematic Syncope
Open accessAbstract
Background —The conventional investigation of patients who present with syncope involves short-term ECG monitoring or provocative testing with head-up tilt and electrophysiological testing. A symptom-rhythm correlation is often difficult to obtain during spontaneous syncope because of its sporadic, infrequent, and unpredictable nature. Methods and Results —We used a prolonged monitoring strategy to determine the cause of syncope in 85 patients (age, 59±18 years; 44 men) with recurrent undiagnosed syncope with an implantable loop recorder capable of cardiac monitoring for up to 18 months. During a mean of 10.5±4.0 months of follow-up, symptoms recurred in 58 patients (68%) 71±79 days (2.3±2.6 months) after implantable loop recorder insertion. An arrhythmia was detected in 42% of patients who recorded a rhythm during recurrent symptoms, with bradycardia present in 18 and tachycardia in 3. Five of the 18 bradycardic patients and 2 additional sinus rhythm patients received a clinical diagnosis of neurally mediated syncope. Patients who experienced presyncope were much less likely to record an arrhythmia during symptoms compared with recurrence of syncope (24% versus 70%, P =0.0005). There were no adverse events associated with recurrent symptoms, and there were no sudden deaths. Inability to freeze after an event occurred in 8 patients, and pocket infection occurred in 3. Conclusions —The strategy of prolonged monitoring is effective and safe in patients with problematic syncope.
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“However, the devices have been shown to improve care in only the subset of patients who are older, have asystole documented on the ILR, and whose tilt test results were negative, probably because many of the diagnoses are of vasovagal syncope.”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [106]
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“These patients appear to benefit from permanent pacing.105–112”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [106]
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“The gold standard for the diagnosis of arrhythmic syncope is when there is a correlation between the symptoms and an ECG recording. 195,196”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [196]
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BackgroundSyncope — Getting to the Heart of the Matter
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“This was comparable to larger series involving younger subjects with syncope (Krahn et al 1999).”
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The Evolution of Ambulatory ECG Monitoring
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Syncope: Diagnosis and Management
Walsh, K., Hoffmayer, K. S., & Hamdan, M. H. (2014) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2014.11.001 · Cited by 51
Diagnostic Evaluation and Management of Patients with Syncope
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The history, science and innovation of Holter technology
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Rogers, J. D., Sanders, P., Piorkowski, C., Sohail, M. R., Anand, R. G., Crossen, K. J., Khairallah, F. S., Kaplon, R. E., Stromberg, K. D., & Kowal, R. C. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.11.001 · Cited by 48
The use of an implantable loop recorder in the investigation of unexplained syncope in older people
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“Medtronic, Minneapolis, USA) offers an additional diagnostic strategy for the investigation of syncope or unexplained falls (Figure 1). The clinical usefulness and cost effectiveness of this device have previously been reported in younger patients with unexplained syncope [ 5 , 6]. The ILR was developed to permit long…”
BackgroundOptimal duration of monitoring in patients with unexplained syncope
Assar, M. D., Krahn, A. D., Klein, G. J., Yee, R. K., & Skanes, A. C. (2003) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.07.042 · Cited by 47
Self-citationSensing issues related to the clinical use of implantable loop recorders
Chrysostomakis, S. I., Klapsinos, N. C., SIMANTIRAKIS, E. N., Marketou, M. E., Kambouraki, D. C., & Vardas, P. E. (2003) · EP Europace · doi:10.1053/eupc.2002.0301 · Cited by 47
Predictive value of presyncope in patients monitored for assessment of syncope
Krahn, A. D., Klein, G. J., Yee, R. K., & Skanes, A. C. (2001) · American Heart Journal · doi:10.1067/mhj.2001.114196 · Cited by 45
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“In about 30% of patients with syncope, despite evaluation including a complete and extensive neurological and cardiac work-up, it is impossible to identify the responsible mechanisms [3,4].”
BackgroundInsertable cardiac monitors: current indications and devices
Sakhi, R., Theuns, D. A. M. J., Szili‐Törok, T., & Yap, S. (2018) · Expert Review of Medical Devices · doi:10.1080/17434440.2018.1557046 · Cited by 43
Moya, A., Brignole, M., Sutton, R., Menozzi, C., Garcia-Civera, R., Wieling, W., Andresen, D., Benditt, D. G., Garcia-Sacristán, J. F., Beiras, X., et al. (2008) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2008.07.043 · Cited by 38
Venugopal, D., PATTERSON, R. P., Jhanjee, R., McKnite, S. H., Lurie, K. G., Belalcazar, A., & Benditt, D. G. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01271.x · Cited by 39
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Cardiac Arrhythmias in the Elderly
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“The implantable loop recorder is capable of cardiac monitoring for up to 18 months and allows ECG recording 20 minutes before and 4 minutes after device activation [ 5 ].”
MethodKothari, D., Riddell, F., Smith, W., Voss, J., & Skinner, J. R. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2006.07.018 · Cited by 37
Rosso, A. D., Ungar, A., Bartoli, P., Cellai, T., Mussi, C., Marchionni, N., Masotti, G., & dell'anziano, T. G. I. D. S. D. S. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50351.x · Cited by 36
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Use of the Implantable Loop Recorder in Evaluation of Patients with Unexplained Syncope
Krahn, A. D., Klein, G. J., Skanes, A. C., & Yee, R. K. (2003) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.14.s9.19.x · Cited by 35
Self-citationShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.005 · Cited by 34
Self-citationBright, J. M., & Cali, J. V. (2000) · Journal of the American Veterinary Medical Association · doi:10.2460/javma.2000.216.1110 · Cited by 34
Implantable loop recorder: towards a gold standard for the diagnosis of syncope?
Brignole, M., MENOZZI, C., Moya‐Mitjans, À., & GARCIA-CIVERA, R. (2001) · Heart · doi:10.1136/heart.85.6.610 · Cited by 31
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Current and Emerging Indications for Implantable Cardiac Monitors
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Implantable loop recorders in the investigation of unexplained syncope: a state of the art review
Parry, S. W., & Matthews, I. G. (2010) · Heart · doi:10.1136/hrt.2010.193417 · Cited by 31
O’Connor, F. G., Levine, B. D., Childress, M. A., Asplundh, C. A., & Oriscello, R. G. (2009) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e3181b732c3 · Cited by 30
“The yield of findings with electrical monitoring is very small in the short term, particularly with athletes whose initial presentation may be in the setting of exercise.(27) In some challenging cases, a continuous-loop event recorder may prove to be more helpful.”
BackgroundBabikar, A., HYNES, B., Ward, N., Oslizok, P., Walsh, K. P., & Keane, D. (2007) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2007.01389.x · Cited by 29
Management of Syncope in Adults: An Update
Chen, L. Y., Benditt, D. G., & Shen, W.-K. (2008) · Mayo Clinic Proceedings · doi:10.4065/83.11.1280 · Cited by 30
Effectiveness and Safety of Remote Monitoring of Patients With an Implantable Loop Recorder
Hernández, Y. D., Toquero‐Ramos, J., Fernández, J. M., Pérez-Pereira, E., Castro‐Urda, V., & Lozano, I. F. (2013) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2013.06.009 · Cited by 29
“El tiempo medio desde el implante al diagnóstico fue 260 (5-947) dı́as en seguimiento convencional, frente a 56 (0-650) dı́as en los pacientes con monitorización a distancia (p < 0,01), lo que llevó a un tratamiento dirigido en este grupo un promedio de 187 dı́as antes sin complicaciones secundarias.”
Background
Metadata
- Authors
- Krahn, A. D., Klein, G. J., Yee, R., Takle-Newhouse, T., & Norris, C.
- Affiliations
- Western University (CA)
- From the Division of Cardiology, University of Western Ontario, London, Ontario, Canada, and Medtronic, Minneapolis, Minn (T.T.-N.).
- Venue
- Circulation
- Published
- 1999-01-26
- Volume
- 99
- Issue
- 3
- Pages
- 406-410
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2006949147
- Semantic Scholar
- 23b308c400504de7e0f85483f49bf75ca93e86b0
- Cited by
- 360
- References
- 27
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 10 · 2023: 5 · 2022: 3 · 2021: 7 · 2020: 5 · 2019: 6 · 2018: 12 · 2017: 22 · 2016: 12 · 2015: 13 · 2014: 13 · 2013: 17 · 2012: 9
- FWCI
- 24.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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
- syncope, implantable loop recorder, prolonged cardiac monitoring, arrhythmia detection, neurally mediated syncope, bradycardia, tachycardia, presyncope, recurrent syncope
- MeSH terms
- Adult, Aged, Arrhythmias, Cardiac, Female, Humans, Male, Middle Aged, Recurrence, Syncope, Electrocardiography, Ambulatory, Tilt-Table Test, Prostheses and Implants
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