Bradycardia risk stratification with implantable loop recorder after unexplained syncope - 21/03/24
, Nicolas Sadoul a, b, Nefissa Hammache a, Nathalie Pace a, Mathieu Echivard a, Luc Freysz a, Hugues Blangy a, Jean Marc Sellal a, b, Arnaud Olivier aHighlights |
• | Typical syncope is the strongest risk factor for SB in patients with US. |
• | 3.46-fold increase in SB risk if aged ≥ 60 years versus younger patients with US. |
• | No traumatic syncope relapse in patients monitored by an ILR. |
• | ILR is safe to research the aetiology of US. |
• | First episode of non-high-risk typical syncope over 60 should indicate use of ILR. |
Abstract |
Background |
An implantable loop recorder is an effective tool for diagnosing unexplained syncope. However, after a first episode in non-high-risk patients, the usefulness of implantable loop recorder implantation remains unclear.
Aims |
To analyse relevant risk factors for significant bradycardia in order to identify patients who do or do not benefit from implantable loop recorder implantation. Also, to study whether implantable loop recorder implantation with remote monitoring is associated with less recurrence of traumatic syncope.
Methods |
This was a retrospective monocentric study including patients with implantable loop recorder implantation after unexplained syncope, using remote monitoring and iterative consultations.
Results |
Two hundred and thirty-seven patients were implanted for unexplained syncope. Significant bradycardia occurred in 53 patients (22.4%): 23 (43.4%) caused by paroxysmal atrioventricular block and 30 (56.6%) caused by sinus node dysfunction, leading to permanent pacemaker implantation in 48 patients. Compared with younger patients, there was a 3.46-fold increase (95% confidence interval 1.92–6.23; P<0.0001) in the risk of significant bradycardia in patients aged≥60 years. Based on multivariable analysis, only “typical syncope” was associated with significant bradycardia occurrence (hazard ratio 3.14, 95% confidence interval 1.75–5.65; P=0.0001). There was no recurrence of significant bradycardia with traumatic complications among patients implanted for traumatic syncope.
Conclusions |
This study shows that: (1) implantable loop recorders identify more significant bradycardia in patients aged≥60 presenting with a first non-high-risk typical syncope, suggesting that an implantable loop recorder should be implanted after a first episode of unexplained syncope in such conditions; and (2) after traumatic syncope, implantable loop recorder implantation is safe, and is associated with little or no recurrence of traumatic syncope.
Le texte complet de cet article est disponible en PDF.Keywords : Implantable loop recorder, Syncope, Conduction disorder, Pacemaker
Abbreviations : AVB, BBB, CI, ESC, HR, ICD, ILR, LBBB, PPM, RBBB, SB, US
Plan
| ☆ | Tweet: Typical syncope is the strongest risk factor for significant bradycardia in patients with unexplained syncope. ILRs should be used promptly after the first episode of non-high-risk typical syncope in patients aged≥60 years. |
Vol 117 - N° 3
P. 186-194 - mars 2024 Retour au numéro
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