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.
OBJECTIVE
To evaluate the usage and diagnostic yield of the implantable loop-recorder (ILR) in detection of the mechanism of syncope and in guiding therapy in patients aged >/=65 years and comparing them with those <65 years.


METHODS
This was a two-hospital, observational, prospective study in consecutive patients with unexplained syncope who underwent an ILR implantation. Between November 1997 and December 2002, a total of 2052 patients with syncope were evaluated (local population of 590,000 inhabitants). The diagnosis remained unexplained in 371 (18%). Of these, 103 patients (5% of the total, 28% of those with unexplained syncope) received an ILR.


RESULTS
There were 70 (76%) patients aged >/=65 years and 25 (24%) <65 years. ILR implantation was 110 and 9 per million inhabitants per year, respectively. During a mean follow-up of 14+/-10 months, syncope was recorded in 52 patients. Compared with younger patients those older had a 2.7 higher syncope recurrence rate (56% vs 32%, P=0.03); arrhythmias were 3.1 times more likely to be responsible for syncope (44% vs 20%, P=0.03). More patients >/=65 years finally received ILR-guided therapy (42% vs 20%, P=0.04). Among the 29 patients (25 of those >/=65 years) who received specific antiarrhythmic therapy, only one (3%), had recurrence of syncope during the subsequent follow-up of 40+/-18 months.


CONCLUSIONS
In patients referred for investigation of unexplained syncope, the older subjects are more likely to have an indication for ILR implantation than those younger, ILR has a higher diagnostic value, an arrhythmia is more likely to be detected and successfully treated.
Brignole
Michele
M
Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, via don Bobbio 25, 16033 Lavagna, Italy. mbrignole@asl4.liguria.it
Menozzi
Carlo
C
Maggi
Roberto
R
Solano
Alberto
A
Donateo
Paolo
P
Bottoni
Nicola
N
Lolli
Gino
G
Quartieri
Fabio
F
Croci
Francesco
F
Oddone
Daniele
D
Puggioni
Enrico
E
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D013575:Syncope / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*
D000889:Anti-Arrhythmia Agents