TY - JOUR
T1 - Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope
AU - Brignole, Michele
AU - Sutton, Richard
AU - Menozzi, Carlo
AU - Garcia-Civera, Roberto
AU - Moya, Angel
AU - Wieling, Wouter
AU - Andresen, Dietrich
AU - Benditt, David G.
AU - Vardas, Panos
N1 - Funding Information:
This study was officially endorsed by the European Heart Rhythm Association and supported by a grant from Medtronic Europe.
PY - 2006
Y1 - 2006
N2 - Aims: This prospective multicentre observational study assessed the efficacy of specific therapy based on implantable loop recorder (ILR) diagnostic observations in patients with recurrent suspected neurally mediated syncope (NMS). Methods and results: Patients with three or more clinically severe syncopal episodes in the last 2 years without significant electrocardiographic and cardiac abnormalities were included. Orthostatic hypotension and carotid sinus syncope were excluded. After ILR implantation, patients were followed until the first documented syncope (Phase I). The ILR documentation of this episode determined the subsequent therapy and commenced Phase II follow-up. Among 392 patients, the 1-year recurrence rate of syncope during Phase I was 33%. One hundred and three patients had a documented episode and entered Phase II: 53 patients received specific therapy [47 a pacemaker because of asystole of a median 11.5 s duration and six anti-tachyarrhythmia therapy (catheter ablation: four, implantable defibrillator: one, anti-arrhythmic drug: one)] and the remaining 50 patients did not receive specific therapy. The 1-year recurrence rate in 53 patients assigned to a specific therapy was 10% (burden 0.07 ± 0.2 episodes per patient/year) compared with 41% (burden 0.83 ± 1.57 episodes per patient/year) in the patients without specific therapy (80% relative risk reduction for patients, P =0.002, and 92% for burden, P = 0.002). The 1-year recurrence rate in patients with pacemakers was 5% (burden 0.05 ± 0.15 episodes per patient/year). Severe trauma secondary to syncope relapse occurred in 2% and mild trauma in 4% of the patients. Conclusion: A strategy based on early diagnostic ILR application, with therapy delayed until documentation of syncope allows a safe, specific, and effective therapy in patients with NMS.
AB - Aims: This prospective multicentre observational study assessed the efficacy of specific therapy based on implantable loop recorder (ILR) diagnostic observations in patients with recurrent suspected neurally mediated syncope (NMS). Methods and results: Patients with three or more clinically severe syncopal episodes in the last 2 years without significant electrocardiographic and cardiac abnormalities were included. Orthostatic hypotension and carotid sinus syncope were excluded. After ILR implantation, patients were followed until the first documented syncope (Phase I). The ILR documentation of this episode determined the subsequent therapy and commenced Phase II follow-up. Among 392 patients, the 1-year recurrence rate of syncope during Phase I was 33%. One hundred and three patients had a documented episode and entered Phase II: 53 patients received specific therapy [47 a pacemaker because of asystole of a median 11.5 s duration and six anti-tachyarrhythmia therapy (catheter ablation: four, implantable defibrillator: one, anti-arrhythmic drug: one)] and the remaining 50 patients did not receive specific therapy. The 1-year recurrence rate in 53 patients assigned to a specific therapy was 10% (burden 0.07 ± 0.2 episodes per patient/year) compared with 41% (burden 0.83 ± 1.57 episodes per patient/year) in the patients without specific therapy (80% relative risk reduction for patients, P =0.002, and 92% for burden, P = 0.002). The 1-year recurrence rate in patients with pacemakers was 5% (burden 0.05 ± 0.15 episodes per patient/year). Severe trauma secondary to syncope relapse occurred in 2% and mild trauma in 4% of the patients. Conclusion: A strategy based on early diagnostic ILR application, with therapy delayed until documentation of syncope allows a safe, specific, and effective therapy in patients with NMS.
KW - Arrhythmias
KW - Diagnosis
KW - Electrocardiography
KW - Loop recorder
KW - Neurally mediated syncope
KW - Pacemaker
KW - Pacing
KW - Prolonged ECG monitoring
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U2 - 10.1093/eurheartj/ehi842
DO - 10.1093/eurheartj/ehi842
M3 - Article
C2 - 16569653
AN - SCOPUS:33646264814
SN - 0195-668X
VL - 27
SP - 1085
EP - 1092
JO - European heart journal
JF - European heart journal
IS - 9
ER -