Журнал старения и гериатрической медицины

Underuse of Implantable Loop Recorders in Elderly Patients with Syncope and Unexplained Falls

Susanne C. de Ruiter, Jeske J. Walgers, Els Doejaaren, Tjeerd Germans, Jaap H. Ruiter and René W.M.M. Jansen

Background: Implantable loop recorders (ILRs) may improve detection of cardiac causes of syncope. Their use in elderly patients is not clear.

Methods: Observational study including patients ≥65 years with unexplained syncope and/or falls undergoing cardiac evaluation, comparing patients with and without cardiac causes on baseline characteristics, indications for pacemaker/ILR, and mortality (mean follow-up ≥1 year). All electrocardiograms (ECGS) were retrospectively re-evaluated.

Results: 374 of a total of 419 patients (mean age 80, SD 6 years) underwent cardiac evaluation. 121 patients had a proven/suspected cardiac cause for the syncope/fall. Ten patients underwent pacemaker/ICD and twelve patients ILR implantation, leading to a diagnosis in five. Sixty patients were advised to undergo ILR implantation after a next event; only three received an ILR during follow-up, although eleven experienced symptoms. Within the group of patients that underwent a cardiac evaluation, there was a higher mortality rate in the cardiac group versus the other causes group (p=0.03). The cardiac group had significantly more ECG abnormalities. Also patients with a cardiac evaluation had more ECG abnormalities (p=0.02). Based on the initial ECG, respectively 9 and 72 patients with a cardiac evaluation had an indication for pacemaker and ILR, but only five patients received a pacemaker and five patients received an ILR. Nine patients without cardiac evaluation (20%) had an indication for ILR based on their ECG.

Conclusions: A substantial number of elderly syncope and fall patients had ECG abnormalities suggestive of a cardiac cause, with an indication for ILR/pacemaker implantation, but only a small number received a device. A cardiac evaluation and early ILR implantation should be considered more often in the diagnostic work-up of unexplained syncope and falls in the elderly.