Humans ; Pediatrics ; methods ; Syncope ; diagnosis ; etiology ; therapy

PURPOSE: The mechanisms underlying syncope remain unknown in about 20% of patients with recurrent syncope. The implantable loop recorder (ILR) has been shown to be a useful diagnostic tool in patients with unexplained syncope even after negative initial evaluations. Nevertheless, ILR has rarely been used in clinical practice. MATERIALS AND METHODS: This study included 18 consecutive patients who had an ILR implanted at our center because of recurrent unexplained syncope after extensive diagnostic tests between February 2006 and June 2011. RESULTS: Diagnosis was confirmed in 10 (55.6%) of the 18 enrolled patients (13 males, 61+/-15 years). The confirmed diagnoses included sick sinus syndrome (n=6, 60%), advanced atrioventricular block (n=2, 20%) and ventricular tachyarrhythmia (n=2, 20%). The mean follow-up durations of the total study subjects and the diagnosed patients were 11.3+/-10.6 months and 5.6+/-9.2 months, respectively. Of the 10 diagnosed patients, 8 (80%) were diagnosed within 6 months of loop recorder implantation. CONCLUSION: ILR may be a valuable and effective diagnostic tool for patients with unexplained syncope.
Adult ; Aged ; Electrocardiography/instrumentation/methods ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic/instrumentation/methods ; Syncope/*diagnosis/etiology

A 55-year-old woman presented with frequent episodes of syncope due to sinus pauses. During ambulatory Holter monitoring, atrial fibrillation and first-degree atrioventricular nodal block were observed. Magnetic resonance imaging and CT scans showed a tumor-like mass from the superior vena cava to the right atrial septum. Open chest cardiac biopsy was performed. The tumor was composed of proliferating IgG4-positive plasma cells and lymphocytes with surrounding sclerosis. The patient was diagnosed with IgG4-related sclerosing disease. Because of frequent sinus pauses and syncope, a permanent pacemaker was implanted. The cardiac mass was inoperable, but it did not progress during the one-year follow-up.
Atrial Septum/*pathology ; Female ; Humans ; Immunoglobulin G/*blood ; Middle Aged ; Pacemaker, Artificial ; Sclerosis/complications/diagnosis/therapy ; Syncope/etiology ; Vena Cava, Superior/*pathology

INTRODUCTIONUnexplained syncope is a common condition with a significant impact both on the patient and on healthcare expenditure. Often, the diagnosis is hampered due to the temporary sporadic nature of the symptoms. Conventional monitoring methods have a low yield for identifying an abnormality during a spontaneous event. The implantable loop recorder (ILR), often underutilised, is an important diagnostic device that may fi ll this void in the early assessment of patients presenting with syncope.

MATERIALS AND METHODSThis article begins with 2 case vignettes which highlight the clinical utility of ILRs in making a definitive diagnosis and guiding subsequent management. This is followed by a review of the existing evidence for ILRs, including the recent international guidelines, underpinning the role of ILRs in the present management algorithm of patients presenting with unexplained syncope. The technical aspects and cost implications will also be reviewed.

RESULTSPresent evidence-based international guidelines have recommended the early use of ILRs in the management of patients with unexplained syncope. Furthermore, there may also be an important role for ILR use in patients with presumed epilepsy refractory to treatment and in the neurally mediated syncope cohort with recurrent symptoms. Cost benefit analysis also demonstrates advantages with early ILR use.

CONCLUSIONThe early use of ILR in selected patients remains an accurate, cost-effective, high yield tool for diagnosis and management of patients with unexplained syncope. However, its use should not detract from the importance of taking a detailed medical history and physical examination in the initial assessment to facilitate identification of the aetiology and risk stratification of patients.

Adult ; Aged ; Algorithms ; Arrhythmias, Cardiac ; complications ; diagnosis ; Cost-Benefit Analysis ; Electrocardiography, Ambulatory ; economics ; instrumentation ; methods ; Female ; Heart Arrest ; complications ; diagnosis ; Heart Diseases ; complications ; diagnosis ; Humans ; Syncope ; diagnosis ; etiology

Child ; China ; Congresses as Topic ; Humans ; Pediatrics ; Syncope ; diagnosis ; etiology ; therapy

OBJECTIVEThis study aimed at analyzing the usefulness of a modified Calgary Syncope Syndrome Score in the differential diagnosis between cardiac syncope (CS) and vasovagal syncope (VVS) in children through a large sample clinical study.

METHODTotally 189 children [112 males, 77 females, aged 2 - 18 yrs, mean age (12.4 ± 3.1) yrs] with CS and VVS who were at the syncope clinic or admitted to the Department of Pediatrics, Peking University First Hospital from August 2002 to April 2011 were included in the study. The diagnosis was analyzed by a modified Calgary Syncope Syndrome Score and receiver operating characteristic (ROC) curve was used to explore the predictive value of different Calgary Syncope Syndrome Scores in differential diagnosis between CS and VVS.

RESULTThere were significant differences in the score between CS [-5.00(-7, 1)] and VVS [1(-4, 6)] (P < 0.01). When the score was ≤ -2.5, the sensitivity and specificity of the differential diagnosis between CS and VVS were 95.4% and 67.7%, respectively. Since the modified Calgary Syncope Syndrome Score was integer number, CS should be considered when the score was less than -3.

CONCLUSIONThe modified Calgary Syncope Syndrome Score might be used as an initial diagnostic method in differential diagnosis between CS and VVS, based on the history of the patients.

Adolescent ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Heart Diseases ; complications ; Humans ; Male ; Sensitivity and Specificity ; Syncope ; diagnosis ; etiology ; Syncope, Vasovagal ; diagnosis ; Tilt-Table Test

Adolescent ; Autonomic Nervous System ; physiopathology ; Blood Pressure ; physiology ; Blood Pressure Monitoring, Ambulatory ; methods ; Child ; Child, Preschool ; Circadian Rhythm ; Female ; Heart Rate ; physiology ; Humans ; Male ; Posture ; physiology ; Syncope, Vasovagal ; diagnosis ; etiology ; physiopathology ; Tilt-Table Test ; Vagus Nerve ; physiopathology

OBJECTIVE: To study the difference between age and gender in patients with micturition syncope (MS). METHODS: A total of 56 patients with MS were diagnosed from 1 542(3-72 years old) cases with unexplained syncope or symptoms of presyncope during micturition in our hospital. The age, onset age, positive rate of head up tilt table test (HUTT) and their correlation with age and gender were analyzed. RESULTS: The average age of patients with MS was older than that of patients with nonmicturition syncope (NMS)[5-67(35.5)years old vs. 3-72(12)years old,Z=-7.587,P<0.01]. Among the patients with MS, adults (>18 years old) were more than children (≤ 18 years old) (9.4% vs. 1.0%,χ2=65.689,P<0.01). There was gender difference in the onset rate of MS (male 5.0% vs. female 2.5%,χ 2=6.858,P<0.01). There was no difference in the positive rate of HUTT between the MS and NMS groups, and between the males and females with MS. There was no difference in age and onset age between the HUTT positive and negative group, and between the males and females. CONCLUSION MS occurs more often in adults and males. Bezold Jazisch reflex may play a role in the mechanism of MS.
Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Posture ; physiology ; Sex Factors ; Syncope ; diagnosis ; etiology ; Tilt-Table Test ; Urination ; Young Adult

PURPOSE: Some patients with neurally mediated reflex syncope may be misdiagnosed as epilepsy because myoclonic jerky movements are observed during syncope. The seizure-like activities during the head-up tilt test (HUT) have been rarely reported. The purpose of this study was to assess the characteristics of these seizure-like activities and evaluate whether there are differences in the clinical characteristics and hemodynamic parameters of patients with neurally mediated reflex syncope with and without seizure-like activities during HUT-induced syncope. MATERIALS AND METHODS: The medical records of 1,383 consecutive patients with a positive HUT were retrospectively reviewed, and 226 patients were included in this study. RESULTS: Of 226 patients, 13 (5.75%) showed seizure-like activities, with 5 of these (2.21%) having multifocal myoclonic jerky movements, 5 (2.21%) having focal seizure-like activity involving one extremity, and 3 (1.33%) having upward deviation of eye ball. Comparison of patients with and without seizure-like activities revealed no significant differences in terms of clinical variables and hemodynamic parameters during HUT. CONCLUSION: Seizure-like activities occurred occasionally during HUT-induced syncope in patients with neurally mediated reflex syncope. The seizure-like activities during HUT might not be related to the severity of the syncopal episodes or hemodynamic changes during HUT.
Adult ; Epilepsy/*pathology ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Syncope/*diagnosis/*etiology/pathology ; Tilt-Table Test/*adverse effects ; Young Adult

Aortic Valve Stenosis ; complications ; diagnosis ; Female ; Humans ; Middle Aged ; Syncope ; diagnosis ; etiology