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[Atypical sinus node dysfunction. Usefulness of implantable Holter. A case report].
J Martí Almor1, J Delclòs Urgell, J Bruguera Cortada
1Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain.
Revista Espanola De Cardiologia
|January 5, 2002
Summary
An 84-year-old female experienced recurrent syncope. An insertable loop recorder revealed presyncope linked to atrial fibrillation and pauses, suggesting prolonged sinus node recovery time.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Recurrent unexplained syncope poses a diagnostic challenge.
- Standard diagnostic tests like ECG, Holter, and EP studies can be inconclusive.
Observation:
- An 84-year-old female presented with a nine-year history of syncopal episodes.
- Initial investigations including ECG, 24-hour Holter, tilt table testing, and electrophysiology (EP) study were negative.
- A subcutaneous insertable loop recorder (Reveal) was implanted for continuous monitoring.
Findings:
- Loop recorder data captured three episodes correlating presyncope with the onset of atrial fibrillation (AF).
- Two syncopal events were associated with an atrial pause occurring between episodes of AF.
- Analysis suggested an abnormally prolonged sinus node recovery time (over 6 seconds) potentially enabling AF recurrence before sinus rhythm restoration.
Implications:
- Continuous monitoring with insertable loop recorders is valuable for diagnosing elusive causes of syncope.
- Prolonged sinus node recovery time may be a significant factor in the pathophysiology of AF-related syncope.
- Understanding these mechanisms can guide future management strategies for patients with recurrent syncope.