Outcomes of Primary vs. Delayed Strategy of Implanting a Cardiac Monitor for Unexplained Syncope
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Settings
2.2. Study Population
2.3. Patients and Public Involvement
2.4. Examination Protocol
2.5. Implantable Loop Recorders
2.6. Clinical Follow-Up
2.7. Statistical Analysis
3. Results
4. Discussion
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- confirmation of diagnosis by reproduction of spontaneous symptoms of VVS on tilt [6]
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- patient education about prodromes and counter-pressure maneuvers on tilt in VVS [6]
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- a basis for pacemaker selection in VVS [7],
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- prognostic information with respect to future syncope recurrence, especially in the context of pacing therapy [8]
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- a diagnosis of carotid sinus syndrome which may call for a different pacemaker program [1],
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- understanding the role of the vasodepressor component in both CSS and VVS implying a possible reduction in hypotensive medication or even addition of medication to support blood pressure [9],
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Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 115) | Primary ILR (n = 52) | Post-CAT ILR (n = 63) | p-Value | |
---|---|---|---|---|
Age, years | 58 ± 18 | 60 ± 17 | 57 ± 20 | 0.412 |
Male sex, n (%) | 73 (63) | 38 (73) | 35 (56) | 0.052 |
Hypertension, n (%) | 38 (33) | 16 (31) | 22 (35) | 0.689 |
GFR, mL/min | 95 ± 34 | 95 ± 32 | 95 ± 36 | 0.998 |
Current smoking, n (%) | 19 (16) | 10 (19) | 9 (14) | 0.477 |
Previous CAD, n (%) | 13 (11) | 2 (4) | 11 (17) | 0.024 |
Previous stroke, n (%) | 7 (6) | 3 (6) | 4 (6) | 0.939 |
Cancer, n (%) | 11 (10) | 8 (16) | 3 (5) | 0.045 |
Diabetes, n (%) | 8 (7) | 6 (11) | 2 (3) | 0.079 |
Heart failure, n (%) | 3 (3) | 1 (2) | 2 (3) | 0.700 |
Atrial fibrillation, n (%) | 11 (10) | 7 (14) | 4 (6) | 0.173 |
Beta-blocker, n (%) | 23 (20) | 10 (20) | 13 (21) | 0.892 |
Diuretics, n (%) | 15 (13) | 6 (11) | 9 (14) | 0.663 |
RAAS inihibitors, n (%) | 27 (23) | 11 (21) | 16 (25) | 0.593 |
Nitrates, n (%) | 2 (2) | 1 (2) | 1 (2) | 0.891 |
SSRI, n (%) | 14 (12) | 6 (11) | 8 (13) | 0.850 |
Prodrome, n (%) | 41 (36) | 19 (37) | 22 (35) | 0.796 |
Fall trauma, n (%) | 82 (72) | 37 (72) | 45 (71) | 0.895 |
Palpitations, n (%) | 27 (24) | 14 (27) | 13 (21) | 0.395 |
Supine syncope, n (%) | 24 (21) | 11 (22) | 13 (21) | 0.903 |
ILR Finding | Total (n = 115) | Issue | Primary ILR (n = 52) | Post-CAT ILR (n = 63) |
---|---|---|---|---|
Sinus arrest or sinus bradycardia <40 bpm | 10 | 1A/2 | 3 | 7 |
AV block | 10 | 1C | 4 | 6 |
Normal sinus rhythm | 67 | 3 | 33 | 34 |
Sinus tachycardia | 4 | 4A | 3 | 1 |
Atrial fibrillation | 13 | 4B | 4 | 9 |
SVT | 9 | 4C | 4 | 5 |
Ventricular tachycardia | 2 | 4D | 1 | 1 |
Pacemaker implantation | 22 | 7 | 15 * | |
Syncope without any of the above arrhythmias (normal sinus rhythm at syncope) | 25 | 3 | 16 | 9 |
Negative (no arrhythmia and no syncope) | 42 | 3 | 17 | 25 |
CAT Finding | Total (115 pts) | Primary ILR (52 pts) | Post-CAT ILR (63 pts) | p-Value |
---|---|---|---|---|
VVS | 39 (34%) | 24 (46%) | 15 (24%) | 0.035 |
OH | 18 (16%) | 11 (21%) | 7 (11%) | 0.058 |
CSS | 6 (5%) | 3 (6%) | 3 (5%) | 0.26 |
Any positive result | 63 (55%) | 38 (73%) | 25 (40%) | <0.001 |
All negative tests | 52 (45%) | 14 (27%) | 38 (60%) | <0.001 |
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Yasa, E.; Intzilakis, T.; Ricci, F.; Melander, O.; Hamrefors, V.; Sutton, R.; Fedorowski, A. Outcomes of Primary vs. Delayed Strategy of Implanting a Cardiac Monitor for Unexplained Syncope. J. Clin. Med. 2022, 11, 1819. https://doi.org/10.3390/jcm11071819
Yasa E, Intzilakis T, Ricci F, Melander O, Hamrefors V, Sutton R, Fedorowski A. Outcomes of Primary vs. Delayed Strategy of Implanting a Cardiac Monitor for Unexplained Syncope. Journal of Clinical Medicine. 2022; 11(7):1819. https://doi.org/10.3390/jcm11071819
Chicago/Turabian StyleYasa, Ekrem, Theodoros Intzilakis, Fabrizio Ricci, Olle Melander, Viktor Hamrefors, Richard Sutton, and Artur Fedorowski. 2022. "Outcomes of Primary vs. Delayed Strategy of Implanting a Cardiac Monitor for Unexplained Syncope" Journal of Clinical Medicine 11, no. 7: 1819. https://doi.org/10.3390/jcm11071819