The Utility Of Insertable Cardiac Monitor In The Accessment Of Syncope

Objective: To investigate the impact of the ICM in the diagnosis and management of adult unexplained syncope.Methods: Seventy-eight patients,from single center,suffered from syncope 2 times or more,with a negative basic clinical work-up,are divided into two groups.One group are with ICM,including 37 patients(mean age 60.20 ± 14.20 yrs,M = 22),another group are without ICM,including 41 patients(mean age 55.88 ± 14.30 yrs,M = 27).The two groups are followed up for more than 6 months until the cause of syncope is confirmed.The diagnosis and treatment of syncope in 2 groups were analysed.The detection rate of arrhythmia was compared between the two groups.Results: In the ICM group,a total of 8 patients(21.62%,n = 37)are identified for the cause of syncope,with a median follow-up time of 164 days.In the control group,no patient(0.0%,n = 41)has a clear diagnosis for the cause of syncope.Seven cases are confirmed arrhythmic syncope(18.92%,n = 37),including sinus arrest in 4 cases,atrial fibrillation with third degree atrioventricular block in 1 case,acute myocardial infarction with junctional bradycardia in 1 case,and supraventricular tachycardia in1 case.One case is diagnosed epilepsy by neurological physician.Five patients with bradycardia underwent cardiac pacing.One patient with supraventricular tachycardia underwent electrophysiological examination and radiofrequency ablation.One patient with acute myocardial infarction underwent coronary angiography and stent implantation,and the patient with epilepsy took antiepileptic drugs.Compared with the control group,the detection rates of long RR interval > 2s,atrial fibrillation,supraventricular tachycardia or atrial tachycardia were higher in the ICM implanted group,with statistically significant(P < 0.05).In the ICM group,there is one case of pocket infection and one case of death.Conclusion: Early implantation of ICM leads to earlier identification of the cause of syncope in patients with unexplained syncope.The main mechanism of syncope without structural heart disease is bradyarrhythmia.