FEASIBILITY OF LONG-TERM ELECTROCARDIOGRAPHIC MONITORING WITH AN IMPLANTED DEVICE FOR SYNCOPE DIAGNOSIS

Patients with infrequent recurrent syncope undiagnosed after extensive noninvasive and invasive testing pose a diagnostic and therapeutic dilemma. The purpose of this pilot study was to assess the feasibility of using an implanted, long‐term monitor as an aid to diagnosis in these patients. This was done using commercially available pacemakers with monitoring functions. Sixteen patients (eight males and eight femaiesj, aged 59.7 ± 17 years who had unexplained syncope despite a 12‐lead electrocardiogram, repeated Holter monitoring, exercise testing, echocardiography, an eJectro‐physioJogical study, and a tiJf test (n = 6), were entered into the study. Patients had experienced a mean of 3.3 ± 1 episodes of syncope in the 12 months prior to the study. All provided a history suggestive of Stokes‐Adams attacks and were referred for consideration of pacemaker implantation. Two patients had ischemic heart disease and one patient had a long QT interval. Patients had an Intermedics Nova II or Medtronic Quintech DPG pulse generator capable of recording sensed and paced events implanted with a single right ventricular lead. Syncope or presyncope occurred in ten patients (62%) 4.9 ± 4.2 months after pacemaker implantation. Bradycardia was detected in six patients and four patients had no arrhythmia. In addition to bradycardia, one patient also had tachycardia detected. Pacing therapy resulted in symptom relief in all six patients with syncope or presyncope due to bradycardia. Complications of pacemaker implantation (lead insulation failure) occurred in two patients. One of these patients subsequently had an infection of the generator pocket with associated systemic sepsis. Although the devices used in this study have serious limitations, the results suggest that continuous long‐term electrocardiographic monitoring can be useful in patients with recurrent syncope and a negative diagnostic work‐up. A smaller device with self‐contained electrodes designed for this purpose would be required for wider applicability. Copyright © 1990, Wiley Blackwell. All rights reserved