The impact of continuous ECG-monitoring in patients with unexplained syncope

Abstract: Introduction: Syncope, is a transient, self-limited loss of consciousness (T-LOC) with an inability to maintain postural tone that is followed by spontaneous recovery.Depending on the mechanism, it has different prognosis. Syncope of cardiac origin has the worst prognosis without treatment. A lot of patients with unexplained syncope need to carry out a variety of different tests, in a variety of specialists. Continuous ECG-monitoring has been a useful clinical tool to establishing the correlation between the symptoms and ECG-results,for example at confirming or excluding an arrhythmia as a mechanism of syncope.Objective:The purpose of this study was to assess the importance of ECG-monitoring in the diagnosis and management of patients with unexplained syncope. We wanted to investigate if it is possible to diagnose those patients earlier and also find the underlying cause of their syncope.Method:This wasaretrospective and descriptive study, which wasperformed by reviewing 60 patients’ files at the department of Cardiology, USÖ.The patients that were referred to the Department of Cardiology, were from September 2009 until December 2017. In order to find the underlying cause of syncope, several diagnostic tests were used, including ECG, Echocardiography, tilt-test, ILR and Holter-ECG.Result:The patients were referredfrom different places, but the most common was the GP(31,6%). 100% of the patients performed ECG but only 28,3% of them had an ILR.From them only 35,2%showed findingsthat successfully helped the diagnosis. The final diagnosisbehind the syncopeafter workup wasvasovagal reaction in33,5%of cases, in 11,6% cardiacreason, 5% orthostatic, 3,32% other causes and 25% unexplained/unknown.Conclusion:Finding themainunderlying cause of syncope still remains difficult to establish. The use of more special diagnostic tests, especially ILR and tilt-test helpsto identify the cause, but still not in high rates. The continuous ECG-monitoring can be a valuable tool for discovering and revealing the underlying causes of unexplained syncope.