| A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. | |
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MedLine Citation:
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PMID: 12867227 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Soori Sivakumaran; Andrew D Krahn; George J Klein; Jane Finan; Raymond Yee; Suzanne Renner; Allan C Skanes |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of medicine Volume: 115 ISSN: 0002-9343 ISO Abbreviation: Am. J. Med. Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-17 Completed Date: 2003-08-18 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 1-5 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, University of Western Ontario, London, Ontario, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Electrocardiography, Ambulatory
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instrumentation* Female Humans Male Middle Aged Prospective Studies Severity of Illness Index Syncope / diagnosis* Time Factors |
| Comments/Corrections | |
Comment In:
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Am J Med. 2003 Jul;115(1):66-7
[PMID:
12867238
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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