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. 2024 Feb;34(1):137-142.
doi: 10.1007/s10286-024-01021-8. Epub 2024 Feb 25.

Asystole on loop recorder in patients with unexplained syncope and negative tilt testing: age distribution and clinical predictors

Vincenzo Russo  1 , Angelo Comune  2 , Erika Parente  2 , Anna Rago  2 , Andrea Antonio Papa  2 , Gerardo Nigro  2 , Michele Brignole  3
Affiliations

Asystole on loop recorder in patients with unexplained syncope and negative tilt testing: age distribution and clinical predictors

Vincenzo Russo et al. Clin Auton Res. 2024 Feb.

Abstract

Background: Approximately 50% of patients with unexplained syncope and negative head-up tilt test (HUTT) who have an electrocardiogram (ECG) documentation of spontaneous syncope during implantable loop recorder (ILR) show an asystolic pause at the time of the event.

Objective: The aim of the study was to evaluate the age distribution and clinical predictors of asystolic syncope detected by ILR in patients with unexplained syncope and negative HUTT.

Methods: This research employed a retrospective, single-center study of consecutive patients. The ILR-documented spontaneous syncope was classified according to the International Study on Syncope of Uncertain Etiology (ISSUE) classification.

Results: Among 113 patients (54.0 ± 19.6 years; 46% male), 49 had an ECG-documented recurrence of syncope during the observation period and 28 of these later (24.8%, corresponding to 57.1% of the patients with a diagnostic event) had a diagnosis of asystolic syncope at ILR: type 1A was present in 24 (85.7%), type 1B in 1 (3.6%), and type 1C in 3 (10.7%) patients. The age distribution of asystolic syncope was bimodal, with a peak at age < 19 years and a second peak at the age of 60-79 years. At Cox multivariable analysis, syncope without prodromes (OR 3.7; p = 0.0008) and use of beta blockers (OR 3.2; p = 0.002) were independently associated to ILR-detected asystole.

Conclusions: In patients with unexplained syncope and negative HUTT, the age distribution of asystolic syncope detected by ILR is bimodal, suggesting a different mechanism responsible for asystole in both younger and older patients. The absence of prodromes and the use of beta blockers are independent predictors of ILR-detected asystole.

Keywords: Age; Asystole; Gender; Predictors; Syncope; Vasovagal syncope.

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Conflict of interest statement

The authors did not report conflicts of interest.

Figures

Fig. 1
Fig. 1
Age distribution (per decades) of ILR detected asystole during lifespan
Fig. 2
Fig. 2
Time from ILR implantation to asystole detection
See this image and copyright information in PMC

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