RECURRENT SYNCOPE : Experience with an Implantable Loop Recorder - 20/09/12

Doi : 10.1016/S0733-8651(05)70338-6

Andrew D. Krahn, MD, George J. Klein, MD, Raymond Yee, MD

Division of Cardiology, University of Western Ontario, London Health Sciences Center, London, Ontario, Canada

Resumen

The cause of recurrent syncope is often difficult to determine if the diagnosis is not evident from initial clinical and laboratory investigations.^{9 Kapoor W.N., Hammill S.C., Gersh B.J. Diagnosis and natural history of syncope and the role of electrophysiologic testing Am J Cardiol 1989 ; 63 : 730-734 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 10 Kapoor W.N., Karpf M., Weiand S. , y al. A prospective evaluation and follow-up of patients with syncope N Engl J Med 1983 ; 309 : 197-204 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 16 Morady F., Shen E., Schwartz A. , y al. Long term follow-up of patients with recurrent unexplained syncope evaluated by electrophysiologic testing J Am Coll Cardiol 1983 ; 2 : 1053-1059 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 20 Sra J.S., Anderson A.J., Sheikh S.H. , y al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing Ann Intern Med 1991 ; 114 : 1013-1019

Haga clic aquí para ir a la sección de Referencias} A cause is not determined after a standardized diagnostic evaluation in 38% to 47% of patients.^{4 Day S.C., Cook E.F., Funkenstein H. , y al. Evaluation and outcome of emergency room patients with transient loss of consciousness Am J Med 1982 ; 73 : 15-23 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 8 Kapoor W.N. Evaluation and outcome of patients with syncope Medicine 1990 ; 69 : 160-175

Haga clic aquí para ir a la sección de Referencias, 10 Kapoor W.N., Karpf M., Weiand S. , y al. A prospective evaluation and follow-up of patients with syncope N Engl J Med 1983 ; 309 : 197-204 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 15 Martin G.J., Adams S.L., Martin H.G. , y al. Prospective evaluation of syncope Ann Emerg Med 1984 ; 13 : 499-504 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} Although patients with negative investigations for syncope are said to have a good prognosis,^{2 Bass E.B., Elson J.J., Fogors R.N. , y al. Long-term prognosis of patients undergoing electrophysiologic studies for syncope of unknown origin Am J Cardiol 1988 ; 62 : 1186-1191 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 6 Denniss A.R., Ross D.L., Richards D.A. , y al. Electrophysiologic studies in patients with unexplained syncope Int J Cardiol 1992 ; 35 : 211-217

Haga clic aquí para ir a la sección de Referencias, 7 Doherty J.U., Pembrook-Rogers D., Grogan E.W. , y al. Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope Am J Cardiol 1985 ; 55 : 703-708 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 13 Kushner J.A., Kou W.H., Kadish A.H. , y al. Natural history of patients with unexplained syncope and a nondiagnostic electrophysiologic study J Am Coll Cardiol 1989 ; 14 : 391-396 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} they continue to suffer from recurrent syncope (19% to 43% over an 18- to 36-month follow-up period) with significant morbidity and a small risk of arrhythmic death.^{2 Bass E.B., Elson J.J., Fogors R.N. , y al. Long-term prognosis of patients undergoing electrophysiologic studies for syncope of unknown origin Am J Cardiol 1988 ; 62 : 1186-1191 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 6 Denniss A.R., Ross D.L., Richards D.A. , y al. Electrophysiologic studies in patients with unexplained syncope Int J Cardiol 1992 ; 35 : 211-217

Haga clic aquí para ir a la sección de Referencias, 7 Doherty J.U., Pembrook-Rogers D., Grogan E.W. , y al. Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope Am J Cardiol 1985 ; 55 : 703-708 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 13 Kushner J.A., Kou W.H., Kadish A.H. , y al. Natural history of patients with unexplained syncope and a nondiagnostic electrophysiologic study J Am Coll Cardiol 1989 ; 14 : 391-396 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 17 Muller T., Roy D., Talajic M. , y al. Electrophysiologic evaluation and outcome of patients with syncope of unknown origin Eur Heart J 1991 ; 12 : 139-143

Haga clic aquí para ir a la sección de Referencias, 20 Sra J.S., Anderson A.J., Sheikh S.H. , y al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing Ann Intern Med 1991 ; 114 : 1013-1019

Haga clic aquí para ir a la sección de Referencias} Many of these patients are unable to drive and can suffer serious injuries associated with recurrent syncope. Little is known regarding the cause of syncope in patients with negative investigations who continue to lose consciousness.

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Esquema

RATIONALE

HISTORICAL PERSPECTIVE

EXPERIENCE WITH THE IMPLANTABLE LOOP RECORDER

Device

Outcome

Comment

FUTURE CONSIDERATIONS

CONCLUSION

Address reprint requests to Andrew D. Krahn, MD, University Campus, London Health Sciences Center, 339 Windermere Road, London, Ontario, Canada, N6A 5A5
This work was supported by a grant from the Heart and Stroke Foundation of Ontario.