Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3)

Ungar, Andrea; Sgobino, Paolo; Russo, Vitantonio; Vitale, Elena; Sutton, Richard; Melissano, Donato; Beiras, Xulio; Bottoni, Nicola; Ebert, H; Gulizia, Michele Massimo; Jorfida, Marcella; Moya, Àngel; Andresen, Dietrich; Grovale, Nicoletta; Brignole, Michele

doi:10.1136/heartjnl-2013-304399

Cited by 54 publications

(27 citation statements)

References 32 publications

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“…In these clinical settings, tilt testing fails to deliver ( Figure 7). Indeed, tilt testing was positive in 51-56% of patients with atypical clinical features suggesting a reflex mechanism, 106,124-128 in 30-36% with unexplained syncope after full investigation, 124,129 and in 45-47% with true cardiac arrhythmic syncope. 130,131 In other words, tilt testing offers little diagnostic value in patients for whom it is most needed.…”

Section: Interpretation Of Tilt Testing Results In Patients With Reflmentioning

confidence: 99%

2018 ESC Guidelines for the diagnosis and management of syncope

Parikka¹

2018

Revista Española de Cardiología (English Edition)

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Section: Interpretation Of Tilt Testing Results In Patients With Reflmentioning

confidence: 99%

2018 ESC Guidelines for the diagnosis and management of syncope

Parikka¹

2018

Revista Española de Cardiología (English Edition)

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“…[7][8][9] The International Study of Syncope of Uncertain Etiology (ISSUE) has highlighted various aspects of ICM utility in a TLOC population. [22][23][24][25] The initial report (ISSUE-1) summarized findings in 111 patients with presumed syncope, an absence of significant structural heart disease, and a normal ECG who underwent ICM implantation. 22 Tilt testing was negative in 82 (isolated syncope) and positive in 29 (tilt-positive).…”

Section: Syncope Evaluationmentioning

confidence: 99%

“…22 In ISSUE-3, retrospective analysis suggested that cardiac pacing was primarily of value in individuals in whom ICM showed marked symptomatic bradycardia, but also in whom tilt-table testing did not show vasodepressor susceptibility. 23 In essence, since reflex syncope typically consists of both cardioinhibitory and vasodepressor aspects, pacing prevention of bradycardia alone may not be adequate to prevent future symptoms unless the vasodepressor component can be shown to be a minor contributor to hypotension. In regard to the time from implant to diagnosis, in ISSUE-3, during a mean observation period of 15 months ± 11 months, the ICM recorded an event in 187 (37%) of 504 patients, with an estimated probability of 31% at one year, 40% at two years, and 47% at three years.…”

Section: Syncope Evaluationmentioning

confidence: 99%

Trends in Subcutaneous Cardiac Monitoring Technology

Kohno

Nantsupawat

Benditt

2018

J Innov Cardiac Rhythm Manage.

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Ambulatory cardiac monitoring is a rapidly expanding field and one that is likely to progress beyond electrocardiographic (ECG) and blood pressure recordings. To date, the primary cardiac monitoring focus has been ambulatory ECG (AECG) monitoring. In this setting, AECG monitoring has become a diagnostic tool used daily by physicians of many specialties. In this regard, both wearable and subcutaneous ECG monitoring technologies are now widely available, with the appropriate choice for a given patient being best determined by the frequency with which the patient's symptom recurrences are expected. In other words, the less frequent the symptomatic events, then the longer the monitoring duration requirement should be. However, multiple factors other than the technology used impact success. For example, wearable AECG systems are only capable of monitoring patients for a period of a few days to several weeks due to limited battery longevity, patient intolerance to cutaneous ECG electrodes, the cumbersome nature of the device, or a combination of these factors. Current-generation insertable cardiac monitors (ICMs), on the other hand, offer three years of monitoring and infrequent skin irritation. Additionally, automatic remote download, a valuable feature in many cases, is only offered by certain wearable technologies, but is an option in all currently available ICMs. This report focuses on the current status of subcutaneous ICMs and their indications and limitations. The goal is to highlight the variety of utility of current ICM technologies and to provide insight into potential future subcutaneous ICM applications.

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“…Nevertheless, this diagnostic yield is a function of observation time. An event recorded by ILR showed an estimated probability of 31% at 1 year, 40% at 2 years and 47% in 3 years [43]. …”

Section: Issues Still To Be Resolvedmentioning

confidence: 99%

The Current Indication for Pacemaker in Patients with Cardioinhibitory Vasovagal Syncope

Silva

Lisboa²

2016

TOCMJ

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The most frequent cause of syncope is vasovagal reflex. It is associated with worse quality of life, depression, fatigue and physical injury. Recurrence of vasovagal syncope is an aggravating, reaching the rate of 69%. Initial step and pharmacological treatment may not work, especially in patients with recurrent syncope without prodrome. These patients can present cardioinhibitory response with asystole. Studies were designed to analyses the effectiveness of pacemaker for prevention of syncope. In this review, nonrandomized clinical trials, open-label randomized, double-blind randomized, placebo-controlled, and studies based on tilt test or Implantable Loop Recorder findings will be discussed.

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Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3)

Abstract: ILR findings showed results other than NMS in a small, although non-negligible, number of patients older than 40 years. TT was unable to discriminate between presumed NMS and non-NMS with the exception of an asystolic response which was highly specific.

Cited by 54 publications

References 32 publications

2018 ESC Guidelines for the diagnosis and management of syncope

2018 ESC Guidelines for the diagnosis and management of syncope

Trends in Subcutaneous Cardiac Monitoring Technology

The Current Indication for Pacemaker in Patients with Cardioinhibitory Vasovagal Syncope

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