Pacemaker implantation based on ambulatory ECG monitoring in patients with cerebral symptoms

Continuous ambulatory ECG monitoring was performed in 110 patients because of a history of dizziness, alleged syncope of vague cerebral manifestations. The resting ECG failed to provide an explanation for symptoms in any of the patients. In 12 patients the monitoring revealed a variety of arrhythmic mechanisms which required pacemaker implantation. Five of these patients had sick sinus syndrome with episodes of prolonged sinus arrest, while in the others various degrees of A-V block were detected. Implantation of a pacemaker relieved the symptoms in all. It is concluded that ambulatory ECG monitoring is essential in evaluating cases of unexplained cerebral symptoms.