title: Additional diagnostic value of implantable loop recorder in patients with initial diagnosis of real or apparent transient loss of consciousness of uncertain origin.
abstract: OBJECTIVE
  Non-syncopal transient loss of consciousness (T-LOC) encompasses disorders that sometimes resemble syncope, and the differential diagnosis with true syncope may be challenging. The implantable loop recorder (ILR) is potentially useful, but has never been systematically assessed. The aim of the study is to evaluate the diagnostic value of ILR in distinguishing syncope from non-syncopal forms of T-LOC.
  
  
  RESULTS
  We implanted an ILR in 58 patients (mean age 71 ± 17 years, 25 males) who had had 4.6 ± 2.3 episodes of real or apparent T-LOC, in order to distinguishing epilepsy from syncope (#28), unexplained fall from syncope (#29), or functional pseudo-syncope from syncope (#1). During 20 ± 13 months of follow-up, 33 patients (57%) had a spontaneous event documented by ILR. A diagnosis of syncope was established by ILR documentation of an arrhythmia in 15 (26%) patients: an asystole of 6 s (IQR 4-10 s) duration was documented at the time of the spontaneous event in seven patients with initial suspicion of epilepsy and in five patients with unexplained fall; atrial tachyarrhythmia was documented at the time of the spontaneous event in 1 and 1 patient, respectively, and ventricular tachycardia in 1 patient with unexplained fall. Conversely, in another 18 patients, ILR monitoring documented no significant rhythm abnormalities at the time of T-LOC recurrence, thus excluding an arrhythmic syncope. Finally, ILR was unable to document any syncopal episode in 25 (43%) patients. Among the 15 patients with an established diagnosis of arrhythmic syncope, syncope recurred during follow-up in 2 of 11 patients who were on pacemaker therapy and in 3 of 4 patients who were on other therapies.
  
  
  CONCLUSIONS
  Implantable loop recorder monitoring provides additional diagnostic value in 'difficult' patients with an initial diagnosis of non-syncopal real or apparent T-LOC.
authors.forename: Roberto
authors.initials: R
authors.lastname: Maggi
authors.affiliation: Dipartimento di Cardiologia, Ospedali del Tigullio, Centro Aritmologico, Lavagna, Italia Syncope Unit, Cardiologia e Medicina Geriatrica, AOU Careggi e Università di Firenze, Firenze, Italia rmaggi@asl4.liguria.it.
authors.forename: Maggi
authors.initials: M
authors.lastname: Roberto
authors.forename: Martina
authors.initials: M
authors.lastname: Rafanelli
authors.affiliation: Dipartimento di Cardiologia, Ospedali del Tigullio, Centro Aritmologico, Lavagna, Italia Syncope Unit, Cardiologia e Medicina Geriatrica, AOU Careggi e Università di Firenze, Firenze, Italia.
authors.forename: Rafanelli
authors.initials: R
authors.lastname: Martina
authors.forename: Alice
authors.initials: A
authors.lastname: Ceccofiglio
authors.affiliation: Dipartimento di Cardiologia, Ospedali del Tigullio, Centro Aritmologico, Lavagna, Italia Syncope Unit, Cardiologia e Medicina Geriatrica, AOU Careggi e Università di Firenze, Firenze, Italia.
authors.forename: Ceccofiglio
authors.initials: C
authors.lastname: Alice
authors.forename: Diana
authors.initials: D
authors.lastname: Solari
authors.affiliation: Dipartimento di Cardiologia, Ospedali del Tigullio, Centro Aritmologico, Lavagna, Italia Syncope Unit, Cardiologia e Medicina Geriatrica, AOU Careggi e Università di Firenze, Firenze, Italia.
authors.forename: Solari
authors.initials: S
authors.lastname: Diana
authors.forename: Michele
authors.initials: M
authors.lastname: Brignole
authors.affiliation: Dipartimento di Cardiologia, Ospedali del Tigullio, Centro Aritmologico, Lavagna, Italia Syncope Unit, Cardiologia e Medicina Geriatrica, AOU Careggi e Università di Firenze, Firenze, Italia.
authors.forename: Brignole
authors.initials: B
authors.lastname: Michele
authors.affiliation: Dipartimento di Cardiologia, Ospedali del Tigullio, Centro Aritmologico, Lavagna, Italia Syncope Unit, Cardiologia e Medicina Geriatrica, AOU Careggi e Università di Firenze, Firenze, Italia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ungar
authors.forename: Ungar
authors.initials: U
authors.lastname: Andrea
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D003937:Diagnosis, Differential; D015716:Electrocardiography, Ambulatory; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome; D014474:Unconsciousness / Q000175:diagnosis* / Q000209:etiology
chemical_list: D000927:Anticonvulsants
keywords: Implantable loop recorder; Non-syncopal transient loss of consciousness; Syncope