Utility of in-hospital cardiac remote telemetry in patients with unexplained syncope.
OBJECTIVE
Cardiac remote telemetry (CR-TEL) is in wide use in cardiac units, but its diagnostic value in the setting of unexplained syncope is unknown.


METHODS
One hundred and two consecutive patients (73 +/- 14 years) arriving to the emergency department due to an unexplained syncope were admitted under CR-TEL. Heart rhythm was continuously monitored from a central station by trained nurses. Events included all causes of mortality and arrhythmias unnoticed on emergency department.


RESULTS
Thirty patients (29.4%) presented events. There were no deaths during the time of monitoring (4.8 +/- 2.7 days). Events requiring transfer to the coronary care units (CCU) occurred in 15 patients (14.7%), principally due to AV-block and extreme bradycardia. Cardiac remote telemetry was diagnostic in 18 patients (17.6%) in whom the arrhythmic event occurred simultaneously with the syncopal episode. Multivariate analysis showed that age > or =86 years (P < 0.01) and heart failure on admission (P < 0.04) were the strongest predictors of events. All transfers to the CCU were documented within the first 4 days. The best cut-off point as a threshold for CR-TEL monitoring time was 72 hours (sensitivity 73%, specificity 86%).


CONCLUSIONS
Cardiac remote telemetry appears to be a useful tool in the management of patients with unexplained syncope, especially in those older and presenting heart failure on admission.
Benezet-Mazuecos
Juan
J
Department of Cardiology, Fundacion Jimenez Diaz-Capio, Universidad Autonoma de Madrid, Madrid, Spain. jbenezet@yahoo.es
Ibanez
Borja
B
Rubio
Jose Manuel
JM
Navarro
Felipe
F
Martín
Edita
E
Romero
Jose
J
Farre
Jeronimo
J
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003325:Coronary Care Units / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011446:Prospective Studies; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology*; D013686:Telemetry / Q000706:statistics & numerical data*