The use of monitoring strategies in patients with unexplained syncope

Abstract

Syncope is a complex clinical syndrome with multiple etiologies that can be very difficult to diagnose. The major obstacles to diagnosis are the periodic and unpredictable nature of events and the high spontaneous remission rate. Short-term electrocardiographic monitoring is often unproductive in patients when initial non-invasive testing is negative, particularly when a paroxysmal arrhythmia is suspected. The external and implantable loop recorders extend the ability to monitor cardiac patients, enhancing the diagnostic yield to as high as 85% in difficult to diagnose syncope. Several recent studies suggest that prolonged monitoring with an implantable loop recorder has a role in patients with syncope and conduction disturbances, negative tilt testing, unexplained seizures and may be superior to conventional testing with tilt and electrophysiologic studies in selected patients.

Syncope in Patients with Organic Heart Disease

“…[95][96][97] Using an ILR, compared with a conventional approach the time to diagnosis is much shorter 98 and the method is cost effective. 99 It would seem that the ILR should be considered earlier in the evaluation of syncope, 100,101 especially if syncope is recurrent, such that unnecessary and nondiagnostic tests can be avoided.…”

Syncope: a clinically guided diagnostic algorithm

“…When the episodes are frequent, Holter monitoring may reveal the arrhythmia. In some cases, these patients may be candidates for prolonged ECG monitoring with an implantable device [3]. Exercise stress testing can unravel myocardial ischemia or exercise-induced arrhythmias.…”

“…The devices diagnose infrequent, recurrent, unexplained syncope [3]. Loop ECG recorders provide extremely useful and frequently diagnostic information.…”

ACE İnhibitörüne Bağlı Öksürük Senkopu

“…In some cases, impairment of cerebral venous return causes cerebral hypo perfusion without decrease of systemic blood pressure. Hypoxia due to temporary airway obstruction, acute increase of cerebrovascular resistance during cough seizures and increase of cerebrospinal fluid pressure and reflex cardiac arrhythmias are the other causes proposed for physiopathology [8][9][10][11][12][13] . Syncope generally develops a few seconds after the start of coughing seizures.…”