The diagnostic yield of implantable loop recorders in unexplained syncope: A systematic review and meta-analysis

Monica Solbiati, Giovanni Casazza, Franca Dipaola, Franca Barbic, Maja Caldato, Nicola Montano, Raffaello Furlan, Robert S. Sheldon, Giorgio Costantino

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Guidelines recommend that implantable loop recorders (ILRs) are used in the evaluation of people with recurrent unexplained syncope in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. The aim of this systematic review was to analyze the diagnostic yield of ILRs in these patients. Methods We performed a systematic search in order to retrieve studies enrolling adults undergoing ILR implantation for undetermined syncope. The primary outcome was the overall diagnostic yield, defined as the proportion of patients with syncope recurrence and an available ILR recording or an automatic detection of a significant arrhythmia. Secondary outcomes were the proportions of patients with the specific etiologic diagnoses on the total of subjects and the proportion of an analyzable ECG recording during symptoms. We used a random effects model for the meta-analyses. Results Forty-nine studies, enrolling 4381 subjects, were included. The overall diagnostic yield was 43.9% (95% CI = 40.2%, 47.6%; I2 = 79.8%). The proportions of subjects finally diagnosed with arrhythmic syncope, ventricular arrhythmias, supraventricular arrhythmias and bradyarrhythmias were 26.5%, 2.7%, 4.9% and 18.2%, respectively. The proportion of an analyzable ECG recording during symptoms was 89.5% (95% CI = 86.1%, 92.1%; 1236 subjects; 36 studies; I2 = 44.9%). Median time to diagnosis was 134 days. Heterogeneity is an important limitation to be acknowledged. Conclusions About a half of unexplained syncope subjects implanted with an ILR were diagnosed, and around 50% of them had an arrhythmia. Life-threatening arrhythmias as well as ILR complications and death due to arrhythmic events were very rare.

Original languageEnglish
Pages (from-to)170-176
Number of pages7
JournalInternational Journal of Cardiology
Volume231
DOIs
Publication statusPublished - Mar 15 2017

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Syncope
Meta-Analysis
Cardiac Arrhythmias
Electrocardiography
Bradycardia
Guidelines
Recurrence

Keywords

  • Arrhythmia
  • Diagnosis
  • Implantable loop recorders
  • Syncope
  • Systematic review

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{ea3419d5f5f04e248400389f245dd87b,
title = "The diagnostic yield of implantable loop recorders in unexplained syncope: A systematic review and meta-analysis",
abstract = "Background Guidelines recommend that implantable loop recorders (ILRs) are used in the evaluation of people with recurrent unexplained syncope in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. The aim of this systematic review was to analyze the diagnostic yield of ILRs in these patients. Methods We performed a systematic search in order to retrieve studies enrolling adults undergoing ILR implantation for undetermined syncope. The primary outcome was the overall diagnostic yield, defined as the proportion of patients with syncope recurrence and an available ILR recording or an automatic detection of a significant arrhythmia. Secondary outcomes were the proportions of patients with the specific etiologic diagnoses on the total of subjects and the proportion of an analyzable ECG recording during symptoms. We used a random effects model for the meta-analyses. Results Forty-nine studies, enrolling 4381 subjects, were included. The overall diagnostic yield was 43.9{\%} (95{\%} CI = 40.2{\%}, 47.6{\%}; I2 = 79.8{\%}). The proportions of subjects finally diagnosed with arrhythmic syncope, ventricular arrhythmias, supraventricular arrhythmias and bradyarrhythmias were 26.5{\%}, 2.7{\%}, 4.9{\%} and 18.2{\%}, respectively. The proportion of an analyzable ECG recording during symptoms was 89.5{\%} (95{\%} CI = 86.1{\%}, 92.1{\%}; 1236 subjects; 36 studies; I2 = 44.9{\%}). Median time to diagnosis was 134 days. Heterogeneity is an important limitation to be acknowledged. Conclusions About a half of unexplained syncope subjects implanted with an ILR were diagnosed, and around 50{\%} of them had an arrhythmia. Life-threatening arrhythmias as well as ILR complications and death due to arrhythmic events were very rare.",
keywords = "Arrhythmia, Diagnosis, Implantable loop recorders, Syncope, Systematic review",
author = "Monica Solbiati and Giovanni Casazza and Franca Dipaola and Franca Barbic and Maja Caldato and Nicola Montano and Raffaello Furlan and Sheldon, {Robert S.} and Giorgio Costantino",
year = "2017",
month = "3",
day = "15",
doi = "10.1016/j.ijcard.2016.12.128",
language = "English",
volume = "231",
pages = "170--176",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - The diagnostic yield of implantable loop recorders in unexplained syncope

T2 - A systematic review and meta-analysis

AU - Solbiati, Monica

AU - Casazza, Giovanni

AU - Dipaola, Franca

AU - Barbic, Franca

AU - Caldato, Maja

AU - Montano, Nicola

AU - Furlan, Raffaello

AU - Sheldon, Robert S.

AU - Costantino, Giorgio

PY - 2017/3/15

Y1 - 2017/3/15

N2 - Background Guidelines recommend that implantable loop recorders (ILRs) are used in the evaluation of people with recurrent unexplained syncope in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. The aim of this systematic review was to analyze the diagnostic yield of ILRs in these patients. Methods We performed a systematic search in order to retrieve studies enrolling adults undergoing ILR implantation for undetermined syncope. The primary outcome was the overall diagnostic yield, defined as the proportion of patients with syncope recurrence and an available ILR recording or an automatic detection of a significant arrhythmia. Secondary outcomes were the proportions of patients with the specific etiologic diagnoses on the total of subjects and the proportion of an analyzable ECG recording during symptoms. We used a random effects model for the meta-analyses. Results Forty-nine studies, enrolling 4381 subjects, were included. The overall diagnostic yield was 43.9% (95% CI = 40.2%, 47.6%; I2 = 79.8%). The proportions of subjects finally diagnosed with arrhythmic syncope, ventricular arrhythmias, supraventricular arrhythmias and bradyarrhythmias were 26.5%, 2.7%, 4.9% and 18.2%, respectively. The proportion of an analyzable ECG recording during symptoms was 89.5% (95% CI = 86.1%, 92.1%; 1236 subjects; 36 studies; I2 = 44.9%). Median time to diagnosis was 134 days. Heterogeneity is an important limitation to be acknowledged. Conclusions About a half of unexplained syncope subjects implanted with an ILR were diagnosed, and around 50% of them had an arrhythmia. Life-threatening arrhythmias as well as ILR complications and death due to arrhythmic events were very rare.

AB - Background Guidelines recommend that implantable loop recorders (ILRs) are used in the evaluation of people with recurrent unexplained syncope in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. The aim of this systematic review was to analyze the diagnostic yield of ILRs in these patients. Methods We performed a systematic search in order to retrieve studies enrolling adults undergoing ILR implantation for undetermined syncope. The primary outcome was the overall diagnostic yield, defined as the proportion of patients with syncope recurrence and an available ILR recording or an automatic detection of a significant arrhythmia. Secondary outcomes were the proportions of patients with the specific etiologic diagnoses on the total of subjects and the proportion of an analyzable ECG recording during symptoms. We used a random effects model for the meta-analyses. Results Forty-nine studies, enrolling 4381 subjects, were included. The overall diagnostic yield was 43.9% (95% CI = 40.2%, 47.6%; I2 = 79.8%). The proportions of subjects finally diagnosed with arrhythmic syncope, ventricular arrhythmias, supraventricular arrhythmias and bradyarrhythmias were 26.5%, 2.7%, 4.9% and 18.2%, respectively. The proportion of an analyzable ECG recording during symptoms was 89.5% (95% CI = 86.1%, 92.1%; 1236 subjects; 36 studies; I2 = 44.9%). Median time to diagnosis was 134 days. Heterogeneity is an important limitation to be acknowledged. Conclusions About a half of unexplained syncope subjects implanted with an ILR were diagnosed, and around 50% of them had an arrhythmia. Life-threatening arrhythmias as well as ILR complications and death due to arrhythmic events were very rare.

KW - Arrhythmia

KW - Diagnosis

KW - Implantable loop recorders

KW - Syncope

KW - Systematic review

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