Abstract
Background
The initial management of syncope or presyncope typically involves short-term cardiac
monitoring using a Holter monitor. A loop recorder is used to extend the period of
monitoring to increase the probability of obtaining a symptom-rhythm correlation.
Loop recorders and Holter monitors are both used commonly, but their utility has not
been compared prospectively.
Methods
Patients with syncope or presyncope referred for a Holter monitor or a loop recorder
were assigned randomly to receive either a 48-hour Holter monitor or a loop recorder
for 1 month as an initial diagnostic strategy. If the initial strategy was unsuccessful,
patients were offered crossover to the alternate strategy.
Results
One hundred patients (mean [± SD] age, 56 ± 20 years; 44 women) with syncope (n =
21), presyncope (n = 29), or both (n = 50) were enrolled. Of the 49 patients assigned
randomly to an external loop recorder first, 31 (63%) had an arrhythmia identified
or excluded, versus 12 (24%) of 51 patients assigned to a Holter monitor initially
(P <0.0001). Arrhythmia was identified as a cause of syncope in 1 patient with a loop
recorder, compared with no patients with a Holter monitor (P = 0.31). Of the 29 patients with negative results with Holter monitoring who went
on to receive a loop recorder, 13 (45%) had arrhythmia excluded, compared with none
of the 4 patients who crossed over to receive a Holter monitor. The overall probability
of obtaining a symptom-rhythm correlation was 56% (44/78) for loop recorders versus
22% (12/55) for Holter monitors (P <0.0001). Despite patient education and test transmissions, 13 (23%) of 57 patients
who had recurrence of their symptoms failed to activate their loop recorder properly.
Conclusion
Loop recorders have a much higher diagnostic yield for patients with syncope or presyncope
as compared with Holter monitors. The utility of loop recorders is limited by some
patients’ inability to operate them correctly.
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Article info
Publication history
Accepted:
February 25,
2003
Received:
October 16,
2002
Footnotes
☆Supported by Grant R98-66 from Physician Services Inc., Toronto, Ontario, Canada. Dr. Krahn is a Research Scholar of the Heart and Stroke Foundation of Canada.
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
