Patient

A 47-year-old severely depressed man without heart disease complained of multiple atypical episodes of syncope without prodrome, triggering event or trauma. ECG and imaging studies were unremarkable. Under pressure from his relatives, a Reveal DX was implanted and the patient was followed remotely by home monitoring.

Graph and trace

A recording was triggered by the patient following a syncopal event and transmitted via home monitoring.

normal sinus rhythm;
oversensing of an artifact during a cardiac cycle creating a spurious appearance of short RR;
sinus rhythm persisting throughout the recording without change in heart rate;
trigger by the patient (symptom).

Comments

The ILR serves to record an ECG at the time of occurrence of symptoms. A diagnosis is made

when a bradycardia is recorded,
when a tachycardia is recorded,
a normal ECG is recorded, eliminating a bradyarrhythmic cause of syncope. The majority of studies report making the latter observation in approximately 1/3 of ILR recipients who develop a recurrence of syncope, classified as an ISSUE Class 3A episode. This patient suffered several episodes without ECG changes. While this long-term monitoring does not allow the making of a definitive diagnosis, it eliminates a rhythmic cause and reassures the patient, which might be therapeutic. After having explained the results and introduced an antidepressive regimen, the symptoms have gradually abated and the patient has remained syncope-free for the past few months.

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Pacing & Defibrillation

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Syncope without changes in cardiac rhythm

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