A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope.
Am J Med
; 115(1): 1-5, 2003 Jul.
Article
em En
| MEDLINE
| ID: mdl-12867227
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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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Síncope
/
Eletrocardiografia Ambulatorial
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Am J Med
Ano de publicação:
2003
Tipo de documento:
Article
País de afiliação:
Canadá