Document Detail

A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope.
MedLine Citation:
PMID:  12867227     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The initial management of syncope or presyncope typically involves short-term cardiac monitoring using a Holter monitor. A loop recorder is used to extend the period of monitoring to increase the probability of obtaining a symptom-rhythm correlation. Loop recorders and Holter monitors are both used commonly, but their utility has not been compared prospectively. METHODS: Patients with syncope or presyncope referred for a Holter monitor or a loop recorder were assigned randomly to receive either a 48-hour Holter monitor or a loop recorder for 1 month as an initial diagnostic strategy. If the initial strategy was unsuccessful, patients were offered crossover to the alternate strategy. RESULTS: One hundred patients (mean [+/- SD] age, 56 +/- 20 years; 44 women) with syncope (n = 21), presyncope (n = 29), or both (n = 50) were enrolled. Of the 49 patients assigned randomly to an external loop recorder first, 31 (63%) had an arrhythmia identified or excluded, versus 12 (24%) of 51 patients assigned to a Holter monitor initially (P <0.0001). Arrhythmia was identified as a cause of syncope in 1 patient with a loop recorder, compared with no patients with a Holter monitor (P = 0.31). Of the 29 patients with negative results with Holter monitoring who went on to receive a loop recorder, 13 (45%) had arrhythmia excluded, compared with none of the 4 patients who crossed over to receive a Holter monitor. The overall probability of obtaining a symptom-rhythm correlation was 56% (44/78) for loop recorders versus 22% (12/55) for Holter monitors (P <0.0001). Despite patient education and test transmissions, 13 (23%) of 57 patients who had recurrence of their symptoms failed to activate their loop recorder properly. CONCLUSION: Loop recorders have a much higher diagnostic yield for patients with syncope or presyncope as compared with Holter monitors. The utility of loop recorders is limited by some patients' inability to operate them correctly.
Soori Sivakumaran; Andrew D Krahn; George J Klein; Jane Finan; Raymond Yee; Suzanne Renner; Allan C Skanes
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  115     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-17     Completed Date:  2003-08-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-5     Citation Subset:  AIM; IM    
Division of Cardiology, University of Western Ontario, London, Ontario, Canada.
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MeSH Terms
Electrocardiography, Ambulatory / instrumentation*
Middle Aged
Prospective Studies
Severity of Illness Index
Syncope / diagnosis*
Time Factors
Comment In:
Am J Med. 2003 Jul;115(1):66-7   [PMID:  12867238 ]

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

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