Utility of in-hospital cardiac remote telemetry in patients with unexplained syncope

Cardiac remote telemetry (CR-TEL) is in wide use in cardiac units, but its diagnostic value in the setting of unexplained syncope is unknown.

One hundred and two consecutive patients (73 +/- 14 years) arriving to the emergency department due to an unexplained syncope were admitted under CR-TEL. Heart rhythm was continuously monitored from a central station by trained nurses. Events included all causes of mortality and arrhythmias unnoticed on emergency department.

Thirty patients (29.4%) presented events. There were no deaths during the time of monitoring (4.8 +/- 2.7 days). Events requiring transfer to the coronary care units (CCU) occurred in 15 patients (14.7%), principally due to AV-block and extreme bradycardia. Cardiac remote telemetry was diagnostic in 18 patients (17.6%) in whom the arrhythmic event occurred simultaneously with the syncopal episode. Multivariate analysis showed that age > or =86 years (P < 0.01) and heart failure on admission (P < 0.04) were the strongest predictors of events. All transfers to the CCU were documented within the first 4 days. The best cut-off point as a threshold for CR-TEL monitoring time was 72 hours (sensitivity 73%, specificity 86%).

Cardiac remote telemetry appears to be a useful tool in the management of patients with unexplained syncope, especially in those older and presenting heart failure on admission.