167 Cinical impact of the implantable loop recorder on patients with isolated syncope, bundle branch block and a negative work-up including an electrophysiological study. A prospective randomized study

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• 作者：Antoine Da Costa¹ ; Pascal Defaye² ; Cé ; cile Romeyer-Bouchard¹ ; J. Claude Deharo³ ; Laurence Bisch¹ ; Dominique Lamaison⁴ ; Karl Isaaz¹
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2011
• 出版时间：January 2011
• 年：2011
• 卷：3
• 期：1
• 页码：55
• 全文大小：57 K

文摘

Background

Little is known in patients with isolated syncope, bundle branch block[BBB], and a negative work-up including an electrophysiological study [EPS]. Norandomized study exists in this subset of patients comparing a strategy of waiting and the implantable loop recorder (ILR).

Objectives

The aim of this multicenterprospective study was to evaluate in a population with BBB and a negative EPS: [1] the prognosis impact of an ILR [group I] compared with the waiting clinical follow-up approach [group II]; [2] the incidence of relevant electrical events.

Methods and Results

From January 2005 to December 2009, 78 pts were included. The mean follow-up was 19 ¡À 12 months. Population characteristics were: mean age of 76 ¡À 8 years old; 30 female [38.5 % ]; 18 cardiomyopathy [23 % ]; previous AFib [15.4 % ]; LVEF [56.5 ¡À 11 % ]; ECG abnormalities [34 left BBB;11 right BB and 33 bifascicular block] and a negative EPS [mean HV interval of 55 ¡À 6 ms]. Seventeen pts [22 % ] developed a significant arrhythmic event: 1 ventricular tachycardia [1.3 % ], 1 sudden death [1.3 % ], 2 AV block II [2.6 % ], 8 AV block III [10.25 % ] and 5 sick sinus syndrome [6.4 % ]. The number of events detected was significantly different between ILR group [n = 13; 16.6 % ] and clinical follow-up [n = 4; 5.1 % ]; (p = 0.02). The Kaplan-Meier estimates of the probability of remaining free of arrhythmia events and the Logrank test [Figure]. In accordance with the final diagnosis, 15 patients received a pacemaker therapy.

Conclusions

This randomized prospective study found that in patients with isolated syncope, BBB and a negative EPS, the % of arrhythmic events is close to 22 % at 2 years. A strategy with an ILR is superior to the clinical follow-up for detecting recurrent events and may influence the prognosis of these patients.