Document Detail

Detection of asymptomatic arrhythmias in unexplained syncope.
MedLine Citation:
PMID:  15309004     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although electrocardiographic monitoring during syncope is the most unambiguous method of diagnosing or excluding an arrhythmia, it requires recurrence of syncope with potential morbidity. We hypothesized that long-term monitoring of patients with syncope would yield significant asymptomatic abnormalities that might preclude waiting for recurrence of actual syncope. METHODS: Sixty patients (age, 67+/-16 years; 27 men) with recurrent unexplained syncope, aged >or=30 years, with a left ventricular ejection fraction >or=35% and negative results on conventional monitoring were enrolled in a prospective study involving long-term automatic arrhythmia detection monitoring with an implantable loop recorder. Pre-specified significant asymptomatic arrhythmias were a pause >5 seconds, 3 degrees atrioventricular block >10 seconds, heart rate (HR) <30 beats/min for >10 seconds while awake, wide complex tachycardia >10 beats, and narrow complex tachycardia >180 beats/min for >30 beats. Borderline asymptomatic arrhythmias included 3- to 5-second pauses, HR <30 beats/min for <10 seconds while awake, HR <30 beats/min for >10 seconds while asleep, and nonsustained wide complex tachycardia or narrow complex tachycardia. RESULTS: Recurrent symptoms developed in 30 patients during the 1-year follow-up period (47%), with arrhythmias detected in 14 patients (23%). Pre-specified significant asymptomatic arrhythmias developed in 9 patients (15%), with bradycardia in 7 patients who underwent pacemaker implantation. Twenty patients (33%) had borderline asymptomatic arrhythmias. Five of these patients (25%) went on to have more pronounced diagnostic arrhythmias of the same mechanism during further follow-up, including pauses of 6 to 17 seconds duration in 3 patients. CONCLUSION: Long-term monitoring of patients with unexplained syncope with automatic arrhythmia detection demonstrated that significant asymptomatic arrhythmias were seen more frequently than anticipated, leading to a change in patient treatment. Automatic arrhythmia detection provides incremental diagnostic usefulness in long-term monitoring of patients with syncope.
Andrew D Krahn; George J Klein; Raymond Yee; Allan C Skanes
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  148     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-08-13     Completed Date:  2005-01-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  326-32     Citation Subset:  AIM; IM    
Division of Cardiology, University of Western Ontario, London, Ontario, Canada.
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MeSH Terms
Arrhythmias, Cardiac / complications,  diagnosis*
Bradycardia / diagnosis
Electrocardiography, Ambulatory* / instrumentation
Follow-Up Studies
Middle Aged
Prospective Studies
Stroke Volume
Syncope / etiology*
Tachycardia / diagnosis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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