Please use this identifier to cite or link to this item: https://scholarbank.nus.edu.sg/handle/10635/124863
Title: The implantable loop recorder-an important addition to the armentarium in the management of unexplained syncope
Authors: Shanmugam, N.
Liew, R. 
Keywords: Electrophysiological study
Epilepsy
External loop recorder
Holter
Tilt testing
Issue Date: Mar-2012
Citation: Shanmugam, N.,Liew, R. (2012-03). The implantable loop recorder-an important addition to the armentarium in the management of unexplained syncope. Annals of the Academy of Medicine Singapore 41 (3) : 115-124. ScholarBank@NUS Repository.
Abstract: Introduction: Unexplained syncope is a common condition with a signifi cant impact both on the patient and on healthcare expenditure. Often, the diagnosis is hampered due to the temporary sporadic nature of the symptoms. Conventional monitoring methods have a low yield for identifying an abnormality during a spontaneous event. The implantable loop recorder (ILR), often underutilised, is an important diagnostic device that may fi ll this void in the early assessment of patients presenting with syncope. Materials and Methods: This article begins with 2 case vignettes which highlight the clinical utility of ILRs in making a defi nitive diagnosis and guiding subsequent management. This is followed by a review of the existing evidence for ILRs, including the recent international guidelines, underpinning the role of ILRs in the present management algorithm of patients presenting with unexplained syncope. The technical aspects and cost implications will also be reviewed. Results: Present evidence-based international guidelines have recommended the early use of ILRs in the management of patients with unexplained syncope. Furthermore, there may also be an important role for ILR use in patients with presumed epilepsy refractory to treatment and in the neurally mediated syncope cohort with recurrent symptoms. Cost benefi t analysis also demonstrates advantages with early ILR use. Conclusion: The early use of ILR in selected patients remains an accurate, cost-effective, high yield tool for diagnosis and management of patients with unexplained syncope. However, its use should not detract from the importance of taking a detailed medical history and physical examination in the initial assessment to facilitate identifi cation of the aetiology and risk stratifi cation of patients.
Source Title: Annals of the Academy of Medicine Singapore
URI: http://scholarbank.nus.edu.sg/handle/10635/124863
ISSN: 03044602
Appears in Collections:Staff Publications

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