Identification of the Causes of Syncope Using a Patch-type ECG Recorder : Efficient Detection of Arrhythmia and Reduction in Implantable Loop Recorder Usage

Abstract

Background : Although 24-hour Holter monitoring is essential to investigate the causes of syncope, it has limitations in capturing infrequent arrhythmias. For patients with suspected cardiac syncope or presyncope symptoms, an implantable loop recorder（ILR）, though invasive, may be necessary to enable long-term electrocardiographic recording. Objective : This study aimed to evaluate the diagnostic yield of cardiogenic syncope using a patch type 7-day ECG recorder, with the aim of exploring the potential to reduce the use of implantable loop recorder（ILR）. Methods : The study retrospectively analyzed 118 patients（70 males, 48 females, average age 68 years）who underwent 7-day ECG monitoring to evaluate cardiogenic syncope between April 2019 and March 2023. The incidence and timing of arrhythmias potentially related to syncope（paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia, non-sustained ventricular tachycardia, sustained ventricular tachycardia, sinus bradycardia, pauses, Mobitz type Ⅱ second-degree AV block and complete AV block）were assessed. Results : Arrhythmias possibly related to syncope were detected in 43 patients（a total of 75 episodes）. Of these, 38 patients（88％）had arrhythmias detected after 24 hours of monitoring. Subsequent treatments included pacemaker implantation in 15 patients（35％）and catheter ablation in 22 patients（51％）. In 36 patients（32％）, catheter ablation or pacemaker implantation was performed without the need for ILR implantation. Conclusion : In patients suspected of cardiogenic syncope or presenting with presyncope symptoms, 7-day ECG monitoring facilitated early diagnosis, potentially avoiding the need for ILR implantation.