The use of an implantable loop recorder in the investigation of unexplained syncope in older people

Armstrong, Valerie; Lawson, John; Kamper, Adriaan M.; Newton, Julia L.; Kenny, Rose Anne

doi:10.1093/ageing/32.2.185

Cited by 41 publications

(21 citation statements)

References 12 publications

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“…15 However, this approach often fails to make a correct diagnosis in older people. 16 Our case report originates from a fortunate coincidence but suggests that a multidimensional geriatric approach can play a leading role in the differential diagnostic assessment between "accidental" and "apparently accidental" falls in the elderly.…”

Section: Case Reportmentioning

confidence: 92%

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Multidisciplinary approach to “accidental” falls in the elderly: A case report

Galizia

Testa

Mazzella

et al. 2008

Geriatrics Gerontology Int

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Falls in the elderly are commonly and often wrongly identified as "accidental". We report a case of an elderly woman admitted to first aid for a trauma due to an accidental fall. Geriatric multidisciplinary evaluation revealed mild cognitive impairment associated with depressive symptoms; both findings made the anamnesis uncertain. Syncope algorithm was applied and "tachy-brady form of sick sinus syndrome" was diagnosed. Differential diagnosis between "accidental" and "apparently accidental" falls in elderly patients is very difficult but a multidisciplinary geriatric evaluation can clarify the correct diagnosis.

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Section: Case Reportmentioning

confidence: 92%

“…In this regard, it should be emphasized that patients with syncope and sick sinus syndrome show a high percentage of positive response to carotid sinus massage 15 . However, this approach often fails to make a correct diagnosis in older people 16 …”

Section: Case Reportmentioning

confidence: 99%

Multidisciplinary approach to “accidental” falls in the elderly: A case report

Galizia

Testa

Mazzella

et al. 2008

Geriatrics Gerontology Int

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“…An activation device is placed over the implanted loop recorder by the patient, family member, or carer after a typical symptomatic episode (Kenny and Krahn 1999). A diagnostic yield of nearly 50% was obtained in a small series of older people with unexplained falls and syncope (Armstrong et al 2003). This was comparable to larger series involving younger subjects with syncope (Krahn et al 1999).…”

Section: Investigationsmentioning

confidence: 99%

Cardiovascular assessment of falls in older people

Tan¹,

Kenny²

2006

Clinical Interventions in Aging

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Falls in older people can be caused by underlying cardiovascular disorders, either because of balance instability in persons with background gait and balance disorders, or because of amnesia for loss of consciousness during unwitnessed syncope. Pertinent investigations include a detailed history, 12-lead electrocardiography, lying and standing blood pressure, carotid sinus massage (CSM), head-up tilt, cardiac electrophysiological tests, and ambulatory blood pressure and heart rate monitoring, which includes external and internal cardiac monitoring. The presence of structural heart disease predicts an underlying cardiac cause. Conversely, the absence of either indicates that neurally mediated etiology is likely. CSM and tilt-table testing should be considered in patients with unexplained and recurrent falls. Holter monitoring over 24 hours has a low diagnostic yield. Early use of an implantable loop recorder may be more cost-effective. A dedicated investigation unit increases the likelihood of achieving positive diagnoses and significantly reduces hospital stay and health expenditure.

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“…The ILR was developed as a means of long-term cardiac monitoring to capture cardiac rhythm during an episode of syncope. 1 Earlier models required activation for the device to store the preceding rhythm segment. The European Society of Cardiology 2009 guidelines on syncope, which American societies endorsed, recommend the ILR for investigating syncope after a negative comprehensive evaluation, 2 but it also emphasized its use earlier in the diagnostic examination if there is a high probability of symptomatic recurrence within the device's battery life.…”

Section: Discussionmentioning

confidence: 99%