Advertisement

Syncope pp 107-125 | Cite as

Prolonged Ambulatory ECG Diagnostic Monitoring … Current and Evolving Indications

  • Michele Brignole
  • David G. Benditt
Chapter

Abstract

In this chapter we describe the role of various prolonged ambulatory ECG monitoring systems (i.e., Holter monitor, external loop recorders [ELR], remote telemetry (mobile cardiac outpatient telemetry [MCOT]), and implantable loop recorders [ILR]) in the diagnostic evaluation of patients with syncope of uncertain cause (i.e., syncope that remains of uncertain nature after the initial evaluation).

Keywords

Structural Heart Disease Holter Monitoring Unexplained Syncope Loop Recorder Syncope Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Moya A, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009;30:2631–2671.PubMedCrossRefGoogle Scholar
  2. 2.
    Brignole M, et al. EHRA position paper. Indications for the use of diagnostic implantable and external ECG loop recorders. Europace. 2009;11:671–687.PubMedCrossRefGoogle Scholar
  3. 3.
    Linzer M, et al. Diagnosing syncope. Part II: Unexplained syncope. Ann Intern Med. 1997;127:76–86.PubMedGoogle Scholar
  4. 4.
    Sivakumaran S, et al. A prospective randomized comparison of loop recorders versus Holter monitoring in patients with syncope or presyncope. Am J Med. 2003;115:1–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Schuchert A, et al. Diagnostic yield of external loop recorders in patients with recurrent syncope and negative tilt table test. Pacing Clin Electrophysiol. 2003;26:1837–1840.PubMedCrossRefGoogle Scholar
  6. 6.
    Linzer M, et al. Incremental diagnostic yield of loop electrocardiographic recorders in unexplained syncope. Am J Cardiol. 1990;66:214–219.PubMedCrossRefGoogle Scholar
  7. 7.
    Rothman S, et al. The diagnosis of cardiac arrhythmias: a prospective multicenter randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring. J Cardiovasc Electrophysiol. 2007;18:241–247.PubMedCrossRefGoogle Scholar
  8. 8.
    Olson JA, et al. Utility of mobile cardiac outpatient telemetry for the diagnosis of palpitations, presyncope, syncope and the assessment of therapy efficacy. J Cardiovasc Electrophysiol. 2007;18:473–477.PubMedCrossRefGoogle Scholar
  9. 9.
    Krahn A, et al. The etiology of syncope in patients with negative tilt table and electrophysiologic testing. Circulation. 1995;92:1819–1826.PubMedCrossRefGoogle Scholar
  10. 10.
    Krahn AD, et al. Use of an extended monitoring strategy in patients with problematic syncope. Reveal Investigators. Circulation. 1999;26(99):406–410.CrossRefGoogle Scholar
  11. 11.
    Nierop P, et al. Heart rhythm during syncope and presyncope. Pacing Clin Electrophysiol. 2000;23:1532–1538.PubMedCrossRefGoogle Scholar
  12. 12.
    Boersma L, et al. Value of implantable loop recorder for the management of patients with unexplained syncope. Europace. 2004;6:70–76.PubMedCrossRefGoogle Scholar
  13. 13.
    Lombardi F, et al. Utility of implantable loop recorder (Reveal Plus) in the diagnosis of unexplained syncope. Europace. 2005;7:19–24.PubMedCrossRefGoogle Scholar
  14. 14.
    Moya A, et al. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation. 2001;104:1261–1267.PubMedCrossRefGoogle Scholar
  15. 15.
    Menozzi C, et al. Mechanism of syncope in patients with heart disease and negative electrophysiologic test. Circulation. 2002;105:2741–2745.PubMedCrossRefGoogle Scholar
  16. 16.
    Brignole M, et al. The mechanism of syncope in patients with bundle branch block and negative electrophysiologic test. Circulation. 2001;104:2045–2050.PubMedCrossRefGoogle Scholar
  17. 17.
    Pierre B, et al. Implantable loop recorder for recurrent syncope: influence of cardiac conduction abnormalities showing up on resting electrocardiogram and of underlying cardiac disease on follow-up developments. Europace. 2008;10:477–481.PubMedCrossRefGoogle Scholar
  18. 18.
    Brignole M, et al. The usage and diagnostic yield of the implantable loop-recorder in detection of the mechanism of syncope and in guiding effective antiarrhythmic therapy in older people. Europace. 2005;7:273–279.PubMedCrossRefGoogle Scholar
  19. 19.
    Solano A, et al. Incidence, diagnostic yield and safety of the implantable loop-recorder to detect the mechanism of syncope in patients with and without structural heart disease. Eur Heart J. 2004;25:1116–1119.PubMedCrossRefGoogle Scholar
  20. 20.
    Brignole M, et al. Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neutrally-mediated syncope. Eur Heart J. 2006;27:1085–1092.PubMedCrossRefGoogle Scholar
  21. 21.
    Pezawas T, et al. Implantable loop recorder in unexplained syncope: classification, mechanism, transient loss of consciousness and role of major depressive disorder in patients with and without structural heart disease. Heart. 2008;94:17–24.CrossRefGoogle Scholar
  22. 22.
    Krahn A, et al. Randomized Assessment of Syncope Trial. Conventional diagnostic testing versus a prolonged monitoring strategy. Circulation. 2006;104:46–51.CrossRefGoogle Scholar
  23. 23.
    Farwell D, et al. The clinical impact of implantable loop recorders in patients with syncope. Eur Heart J. 2006;27:351–356.PubMedCrossRefGoogle Scholar
  24. 24.
    Brignole M, et al. Proposed electrocardiographic classification of spontaneous syncope documented by an Implantable Loop Recorder. Europace. 2005;7:14–18.PubMedCrossRefGoogle Scholar
  25. 25.
    Sud S, et al. Implications of mechanism of bradycardia on response to pacing in patients with unexplained syncope. Europace. 2007;9:312–318.PubMedCrossRefGoogle Scholar
  26. 26.
    Krahn A, et al. Predicting the outcome of patients with unexplained syncope undergoing prolonged monitoring. Pacing Clin Electrophysiol. 2002;25:37–41.PubMedCrossRefGoogle Scholar
  27. 27.
    Brignole M, et al. Improved arrhythmia detection in implantable loop recorders. J Cardiovasc Electrophysiol. 2008;19:928–934.PubMedCrossRefGoogle Scholar
  28. 28.
    Vitale E, et al. Discrepancy between clinical practice and standardized indications for ILR in patients with unexplained syncope. A SUP substudy. Europace. 2010;12:1475–1479.Google Scholar
  29. 29.
    Brignole M, et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J. 2006;27:76–82.PubMedCrossRefGoogle Scholar
  30. 30.
    Brignole M, et al. Prospective multicentre systematic guideline-based management of patients referred to the Syncope Units of general hospitals. Europace. 2010;12:109–118.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Dipartimento di Cardiologia, Centro AritmologicoOspedali del TigullioLavagnaItaly
  2. 2.Cardiac Arrhythmia CenterMedical School, University of MinnesotaMinneapolisUSA

Personalised recommendations