Randomized assessment of syncope trial - Conventional diagnostic testing versus a prolonged monitoring strategy

Article

关键词: HEAD-UP TILT;    UNEXPLAINED SYNCOPE;    UNKNOWN ORIGIN;    FOLLOW-UP;    ELECTROPHYSIOLOGIC EVALUATION;    RECURRENT SYNCOPE;    LOOP RECORDER;    ISOPROTERENOL;    ETIOLOGY;    TABLE;   

DOI  :  10.1161/01.CIR.104.1.46

来源: SCIE

【 摘 要 】

Background-Establishing a diagnosis in patients with unexplained syncope is complicated by infrequent and unpredictable events. Prolonged monitoring may be an alternative strategy to conventional testing with short-term monitoring and provocative tilt and electrophysiological testing. Methods and Results-Sixty patients (aged 66 +/- 14 years, 33 male) with unexplained syncope were randomized to conventional testing with an external loop recorder and tilt and electrophysiological testing or to prolonged monitoring with an implantable loop recorder with 1 year of monitoring. If patients remained undiagnosed after their assigned strategy, they were offered crossover to the alternate strategy. A diagnosis was obtained in 14 of 27 patients randomized to prolonged monitoring compared with 6 of 30 patients undergoing conventional testing (52% versus 20%, P=0.012), Crossover was associated with a diagnosis in I of 6 patients undergoing conventional testing compared with 8 of 13 patients who completed monitoring (17% versus 62%, P=0.069). Overall, prolonged monitoring was more likely to result in a diagnosis than was conventional testing (55% versus 19%, P=0.0014). Bradycardia was detected in 14 patients undergoing monitoring compared with 3 patients undergoing conventional tasting (40% versus 8%, P=0.005). Conclusions-A prolonged monitoring strategy is more likely to provide a diagnosis than conventional testing in patients with unexplained syncope. Consideration should be given to earlier implementation of a monitoring strategy.

【 授权许可】

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