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. 2021 Sep;26(5):e12850.
doi: 10.1111/anec.12850. Epub 2021 May 6.

Syncope associated with supraventricular tachycardia: Diagnostic role of implantable loop recorders

Stergios Soulaidopoulos  1 , Petros Arsenos  1 , Ioannis Doundoulakis  1 , Dimitrios Tsiachris  2 , Christos-Konstantinos Antoniou  1 , Polychronis Dilaveris  1 , Nikolaos Fragakis  3 , Melani Sotiriadou  3 , Skevos Sideris  4 , Athanasios Kordalis  1 , Ageliki Laina  1 , Dimitrios Tousoulis  1 , Konstantinos Tsioufis  1 , Konstantinos A Gatzoulis  1
Affiliations

Syncope associated with supraventricular tachycardia: Diagnostic role of implantable loop recorders

Stergios Soulaidopoulos et al. Ann Noninvasive Electrocardiol. 2021 Sep.

Abstract

Syncope represents a relatively uncommon symptom of supraventricular tachycardia (SVT). It is likely that an impaired autonomic vasomotor response to the hemodynamic stress of tachycardia is the determinant of hemodynamic changes leading to cerebral hypoperfusion and syncope. In this regard, tilt-table test may detect abnormalities in the autonomic nervous function and predict the occurrence of syncope during SVT. Electrophysiology studies may reproduce the SVT, distinguish it from other life-threatening ventricular tachyarrhythmias, and exclude other causes of syncope. Not infrequently mixed syncope mechanisms are revealed during the above diagnostic workup raising doubts about the operating mechanism in the clinical setting. In such cases of uncertainty, an implantable loop recorder, providing long-term cardiac monitoring, may play a pivotal role in the establishment of the diagnosis, confirming the association of an arrhythmic event with the symptom. Herein, we present four such cases with recurrent unexplained syncope finally attributed to paroxysmal SVT guiding them to a potentially radical treatment through radiofrequency catheter ablation.

Keywords: electrophysiology test; implantable loop recorder; supraventricular tachycardia; syncope; tilt-table test.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Implantable loop recorder data demonstrating an episode of supraventricular tachycardia at an average rate of 207 bpm, self‐terminating after 9 s, clinically presenting with presyncope
FIGURE 2
FIGURE 2
A supraventricular tachycardia episode with an average ventricular rate of 194 bpm and a duration of 5 s detected by an implantable loop recorder, inducing syncope
FIGURE 3
FIGURE 3
Implantable loop recorder data detecting a supraventricular tachycardia syncopal episode with a median ventricular rate of 214 bpm and a duration of at least 24 s
FIGURE 4
FIGURE 4
Implantable loop recorder data from a grown‐up congenital heart disease patient showing a regular fast tachycardia run with a median ventricular rate of 222 bpm, self‐terminating after 26 s, associated with syncope
See this image and copyright information in PMC

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