SPC365

Unraveling the story of hundreds of syncopes and pre-syncopes

Session: Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker: MARIANA GOMES TINOCO

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Mariana Tinoco; Margarida Castro; Luísa Pinheiro; Lucy Calvo; Filipa Almeida; Silvia Ribeiro; Filipa Cardoso; Bernardete Rodrigues; Claudia Mendes; Assunção Alves; Victor Sanfins; António Lourenço

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><span style="background-color:white">Background:</span></strong><span style="background-color:white"> Implantable loop recorders (ILR) improve diagnostic yield in unexplained syncope patients (P), as syncope&#39;s sporadic nature and unpredictable recurrence make it challenging to determine its etiology. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><span style="background-color:white">Purpose:</span></strong><span style="background-color:white"> To assess the diagnostic yield of ILR and subsequent therapeutic interventions.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><span style="background-color:white">Methods:</span></strong><span style="background-color:white"> Single-center retrospective study of P who implanted an ILR for the study of unexplained syncope or pre-syncope between 2000 and 2023. The primary endpoint was a documented arrhythmia requiring device implantation during the follow-up. </span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><span style="background-color:white">Results:</span></strong><span style="background-color:white">&nbsp; 595P were included (mean age 68&plusmn;14 years; 50% female). The majority of P (543; 91%) had a normal ejection fraction. 134P (23%) had atrial fibrillation (AF). In terms of basal ECG characteristics, 86P (15%) had 1st degree atrioventricular block (AVB), 60 (10%) had left bundle branch block (L-BBB), 68 (11%) had R-BBB, and 40 (7%) had bifascicular block. Prior to ILR implantation, all P underwent ECG and echocardiogram, with 87% also undergoing 24H-Holter, 14% tilt test, and 8% electrophysiological study. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">During a median follow-up of 21 (IQR 7-38) months, 194P (33%) required device implantation due to significant arrhythmias <span style="background-color:white">(88% pacemaker, 9% ICD, 3% CRT)</span>. Median duration from ILR until device implantation was 6 (IQR 2-14) months. The indications were sick sinus syndrome in 101P (52%), advanced AVB in 66P (34%), ventricular tachycardia in 14P (7%), and symptomatic slow AF in 13P (7%). <span style="background-color:white">Additionally, 8% (50P) experienced AF/AFL episodes (2min to 70h), with 24% (12P) reporting symptoms and 84% (42P) starting anticoagulation. </span>Symptoms without correlation with diagnostic findings were reported in 25P (8%).</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive">P who required device implantation were older (72&plusmn;13 vs 66&plusmn;15 years, p&lt;0.001) and had a higher prevalence of hypertension (73% vs 56%, p&lt;0.001), AF (31% vs 18%, p&lt;0.001), obstructive sleep apnea syndrome (OSAS) (11% vs 5%, p=0.007), and LVH (32% vs 19%, p&lt;0.001).</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><span style="background-color:white">In a multivariate analysis, age&gt;75 years (HR: 1.6; 95% CI 1.1-2.4), AF (HR: 1.6; 95% CI 1.1-2.4), hypertension (HR: 1.6; 95% CI 1.1-2.3), and OSAS (HR: 2.5; 95% CI 1.3-4.8) were identified as independent predictors for device implantation.</span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:14px"><span style="font-family:Comic Sans MS,cursive"><strong><span style="background-color:white">Conclusion:</span></strong> ILR<span style="background-color:white"> was a useful diagnostic tool, providing additional value to other methods. After the disorder was unveiled by the ILR, 41% of P required intervention. Advanced age, AF, hypertension, and OSAS were independent predictors for device implantation, which may help identify a higher-risk group and should be considered during the initial workup.</span></span></span></p>