title: Wearable sensors in syncope management.
abstract: Syncope is a common disorder with a lifetime prevalence of about 40%. Implantable cardiac electronic devices, including implantable loop recorders (ILR) and implantable cardioverter-defibrillators (ICD), are well established in syncope management. However, despite the successful use of ILR and ICD, diagnosis and therapy still remain challenging in many patients due to the complex hemodynamic interplay of cardiac and vascular adaptations during impending syncopes. Wearable sensors might overcome some limitations, including misdiagnosis and inappropriate defibrillator shocks, because a variety of physiological measures can now be easily acquired by a single non-invasive device at high signal quality. In neurally-mediated syncope (NMS), which is the most common cause of syncope, advanced signal processing methodologies paved the way to develop devices for early syncope detection. In contrast to the relatively benign NMS, in arrhythmia-related syncopes immediate therapeutical intervention, predominantly by electrical defibrillation, is often mandatory. However, in patients with a transient risk of arrhythmia-related syncope, limitations of ICD therapy might outweigh their potential therapeutic benefits. In this context the wearable cardioverter-defibrillator offers alternative therapeutical options for some high-risk patients. Herein, we review recent evidence demonstrating that wearable sensors might be useful to overcome some limitations of implantable devices in syncope management.
authors.affiliation: Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Informatics Engineering, Science and Technology, Faculty of the University of Coimbra, Coimbra, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Carvalho
authors.affiliation: Department of Electrophysiology, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Brinkmeyer
authors.affiliation: Department of Electrophysiology, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Department of Informatics Engineering, Science and Technology, Faculty of the University of Coimbra, Coimbra, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Couceiro
authors.affiliation: Research Group 'Patient Care Solutions', Philips Research Europe, Eindhoven, Netherlands.
authors.forename: Jens
authors.initials: J
authors.lastname: Mühlsteff
mesh_terms: D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis; D003645:Death, Sudden / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004867:Equipment Design; D006439:Hemodynamics; D006801:Humans; D008904:Miniaturization; D018670:Monitoring, Ambulatory / Q000295:instrumentation* / Q000379:methods*; D009474:Neurons / Q000473:pathology; D015995:Prevalence; D019736:Prostheses and Implants; D013575:Syncope / Q000628:therapy*