The implantation of a loop recorder to detect the cause of pre-syncope in an 85-year-old man

Abstract

The patient was an-85-year-old man with hypertension and hyperlipidemia. The patient had a history of faintness on standing. He visited our hospital after experiencing chest oppression and pre-syncope in 2015. Brain magnetic resonance imaging and echocardiography did not detect any structural brain or heart disease. Ischemic heart disease was suspected based on the myocardial scintigraphy findings, but coronary angiography revealed no unusual findings. Holter electrocardiography did not reveal the reason for his symptoms. Because he had experienced 2-second sinus arrest rather than faintness or pre-syncope during the Holter monitoring (not an indication for the implantation of a pacemaker), we implanted a loop recorder to detect the cause of pre-syncope.

The loop recorder required that he or his family to manually send the telemetry monitoring data, but he and his wife did not understand how to do it. After the loop recorder failed to reveal the cause of his symptoms, he was hospitalized for its extraction. When we manually checked the loop recorder data on the day of hospitalization, sinus arrest of >3 seconds was detected 271 times; the maximum sinus arrest was 4 seconds. Sinus arrest was confirmed to be cause of his symptoms. His symptoms completely disappeared after the implantation of a permanent pacemaker.

Although faintness is not rare in elderly people, it can be difficult to diagnose. An implantable loop recorder was useful for diagnosing pre-syncope; however, in the present case, it was difficult for the elderly patient and his wife to perform telemetry monitoring.