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Clinical Predictors of Pacemaker Implantation in Patients with Syncope Receiving Implantable Loop Recorder with or without ECG Conduction Abnormalities
Author(s) -
AHMED NAUMAN,
FRONTERA ANTONIO,
CARPENTER ALEXANDER,
CATALDO STAFENIA,
CONNOLLY GEORGIA M.,
FASIOLO MATTEO,
CRIPPS TIM,
THOMAS GLYN,
DIAB IHAB,
DUNCAN EDWARD R.
Publication year - 2015
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12666
Subject(s) - medicine , bradycardia , implantable loop recorder , cardiology , syncope (phonology) , odds ratio , asymptomatic , confidence interval , sinus bradycardia , retrospective cohort study , population , atrial fibrillation , heart rate , blood pressure , environmental health
Background Implantable loop recorders (ILR) allow prolonged cardiac rhythm monitoring and improved diagnostic yield in syncope patients. Predictive factors for pacemaker (PM) implantation in the ILR population with unexplained syncope have not been adequately investigated. In this single center, retrospective, observational study we investigated factors that predict PM implantation in this population. Methods We retrospectively analyzed our ILR database of patients aged over 18 years who underwent ILR implantation for unexplained syncope between January 2009 and June 2013. Patient case notes were examined for demographics, history, electrocardiogram (ECG) abnormalities, investigations, and events during follow‐up. The primary end‐point was the detection of a symptomatic or asymptomatic bradycardia requiring PM implantation. Results During a period of 4.5 years, 200 patients were implanted with ILR for unexplained syncope, of who n = 33 (16.5%) had clinically significant bradycardia requiring PM implantation. After multivariable analysis, history of injury secondary to syncope was found to be the strongest independent predictor for PM implantation (odds ratio [OR]:9.1; P < 0.001; 95% confidence interval [CI]: (3.26–26.81). Other significant predictors included female sex, PR interval > 200msec, and age >75 years. In patients without conduction abnormalities on the ECG, history of injury secondary to syncope was found to be the strongest independent predictor for PM implantation (OR: 8.16; P = 0.00027; 95% [CI]: (2.67–26.27). Conclusions A history of injury secondary to syncope and female sex were independent predictive factors for bradycardia necessitating PM implantation in patients receiving an ILR for syncope with or without ECG conduction abnormalities.