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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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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