Background Establishing a symptom–rhythm correlation in patients with unexplained syncope is complicated because of its sporadic, infrequent, and unpredictable nature. Prolonged monitoring with an implantable loop recorder (ILR) allows the recording of electrocardiogram (ECG) data from a spontaneous syncopal event. Hypothesis The aim of this study was to evaluate the usefulness of the ILR for the diagnosis of syncope of unknown origin after conventional management in clinical practice. Methods We reviewed the results with ILR implantation in patients with syncope of unknown origin after conventional management in the cardiology department at HU Marques de Valdecilla (Santander, Cantabria, Spain). Results One hundred and forty patients (age 64 ± 16 y; 86 male [62%]) with syncope of unknown etiology after conventional work‐up underwent prolonged monitoring with an ILR from September 1998 to February 2006; 46 patients (33%) had structural heart disease. During a mean follow‐up of 346 ± 160 d, 51 patients (36.5%) had recurrent syncope with diagnostic ECG recording. An arrhythmic cause for syncope was found in 33 of them (64.5%), with bradycardia present in 27 (53%) and tachycardia in 6 (11%). There were no sudden deaths, and 1 patient suffered a complication related to a recurrence of syncope. Conclusion Long‐time experience with the ILR confirmed the utility of this device in the diagnosis of unexplained syncope in clinical practice. Most of these patients had syncope of arrhythmogenic etiology that could be successfully treated. This strategy of prolonged monitoring is safe even in patients with structural heart disease. Copyright © 2009 Wiley Periodicals, Inc.

Delayed pericardial tamponade (PT) after penetrating heart trauma is now a rare condition as a result of advances in medical and surgical management. We report the case of a 32-year-old man with delayed PT after a stab wound from a knife. The initial evaluation was consistent with a traumatic apical myocardial infarction. After an uneventful initial course, the patient developed acute PT, which required emergency surgery. A thrombus was discovered over a laceration in the mid-segment of the left anterior descending artery and a simple suture was performed.

Isolated noncompaction of left ventricular myocardium (IVNC) is categorized as an unclassified cardiomyopathy by the World Health Organization. We describe the case of a 29-year-old woman who was diagnosed with IVNC after suffering two syncopes caused by an atrioventricular nodal reentrant tachycardia (AVNRT) that was successfully ablated. We report successful radiofrequency ablation in an adult with this cardiomyopathy. Although the presence of syncope in these patients obliged us to rule out a ventricular tachycardia as the most probable etiology, our case shows how an exhaustive study is needed to look for other possible and curable causes.

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