title: Diagnostic superiority of continuous-loop electrocardiographic recording over other testing in a patient with recurrent syncope and underlying coronary artery disease with severe left ventricular dysfunction.
abstract: Dysrhythmic causes of syncope may elude diagnosis in postinfarction patients despite elaborate testing, including electrophysiologic study. For a correct diagnosis, capture of cardiac rhythm during patient's typical symptoms is crucial. This report describes a patient with coronary artery disease and decreased left ventricular ejection fraction who experienced recurrent syncopal episodes without obvious precipitating factors. The 12-lead electrocardiogram showed left bundle-branch block indicating a possible conduction abnormality as the underlying cause of syncope. Twenty-four-h Holter monitoring exhibited no sinus rhythm or conduction disturbances but revealed a nonsustained run of ventricular tachycardia. Findings at electrophysiologic testing led to a presumptive diagnosis of tachyarrhythmic cause of syncope; however, the correct diagnosis was only made with use of a loop monitor which documented a 15-s sinus pause during a syncopal episode.
authors.affiliation: Cardiology Division, Patras University Medical School, Rio, Greece.
authors.forename: J A
authors.initials: JA
authors.lastname: Chiladakis
authors.forename: P
authors.initials: P
authors.lastname: Davlouros
authors.forename: E
authors.initials: E
authors.lastname: Simeonidou
authors.forename: A S
authors.initials: AS
authors.lastname: Manolis
mesh_terms: D000368:Aged; D001919:Bradycardia / Q000175:diagnosis*; D003327:Coronary Disease / Q000150:complications*; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D012008:Recurrence; D013575:Syncope / Q000209:etiology*; D018487:Ventricular Dysfunction, Left / Q000150:complications*