THE ROLE OF ECG RECORDING AND MONITORING FOR THE EVALUATION OF THE SYNCOPE
Authors: Cristian Podoleanu
The initial evaluation of the syncope, defined as a transient loss of consciousness due to cerebral hypoperfusion, is aimed to identify the underlying mechanism and to stratify the risk and the prognosis of the patient. The importance of the ECG recording and monitoring relies in the need to choose the optimal treatment, based on the pathophysiological substrate.
Standard ECG recording is indicated as part of the initial evaluation and in some cases can offer significant clues to the etiology of the syncope. When symptoms are present with ECG evidence of acute ischemia with or without myocardial infarction, independently of its mechanism, well-defined arrhythmias (bradycardic or tachycardic) or pacemaker dysfunction a certain diagnosis can be made and appropriate treatment can be chosen.
In other instances the initial ECG recording can be leading to a suspected diagnosis that has to be confirmed by further investigations. If reflex syncope is suspected head-up tilt testing is capable to reproduce a syncopal episode but the correlation of the induced ECG changes with the rhythm during the spontaneous event is not optimal and can be misleading for the selection of the optimal therapy.
ECG monitoring of shorter or longer duration, performed in-hospital settings by telemetry or by wearable recorders in out-patient setting is able to identify the electrocardiographic substrate of the syncope and to select the optimal treatment but delays the therapeutical intervention until the occurrence of the spontaneous event.