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Lookup NU author(s): Emerita Professor Julia Newton, Professor Rose Anne Kenny
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Introduction: Reveal is a patient activated implantable loop recorder device with an 18 month battery life now available to assist in the diagnosis of suspected syncope or arrhythmias. We present our experience using this device in older subjects referred to a dedicated falls and syncope clinic in whom usual clinical assessment had not satisfactorily identified an attributable diagnosis but where we still suspected a cardiovascular cause for syncope or falls. Methods and results: during the past 3 years 15 subjects (mean age 73 years, range 61-89 years) had Reveal implanted for symptoms of syncope alone (n = 6; 40%) and unexplained falls (n = 3; 20%) or symptoms of syncope and unexplained falls (n = 6; 40%). Symptom duration was long (mean 48 months; range 4-200 months). Subjects had experienced significant morbidity, 6 subjects (40%) required A&E attendance or hospital admission and 4 (27%) experienced a fracture. Despite extensive and repeated investigations, which included 12-lead ECG, echocardiogram, 24-h ambulatory heart rate monitor, 24-h ambulatory blood pressure monitor, orthostatic blood pressure measurement, supine and erect carotid sinus massage, electroencephalogram, and passive and GTN head up tilt testing, the attributable diagnosis remained unexplained. Of the 15 subjects, 7 have activated the device at 4 (range 0-14) months after implantation. Bradycardia was identified in 3 and ventricular tachycardia in 1 subject. Two subjects did not activate the device during the 18 months it was in-situ. Four people had problems with device activation. This is comparable to rates noted using Reveal in younger subjects. Conclusion: Reveal offers additional diagnostic yield in complex elderly subjects with suspected cardiovascular causes of syncope or unexplained falls which have not been previously satisfactorily diagnosed despite extensive investigations.
Author(s): Armstrong VL, Lawson J, Kamper AM, Newton J, Kenny RA
Publication type: Article
Publication status: Published
Journal: Age and Ageing
Year: 2003
Volume: 32
Issue: 2
Pages: 185-188
ISSN (print): 0002-0729
ISSN (electronic): 1468-2834
Publisher: Oxford University Press
URL: http://dx.doi.org/10.1093/ageing/32.2.185
DOI: 10.1093/ageing/32.2.185
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