Commonly Searched EP Topics
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EP Lab Digest - Syncope
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Permanent pacemakers are small, battery-operated devices that help the heart beat in a regular rhythm. Some pacemakers are permanent (internal), and some are temporary (external). Feel free to browse through EP Lab Digest's collection of articles on this topic.
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Syncope Management in the Emergency Department Utilizing a Multidisciplinary Approach (SEEDS Study)
Syncope is defined as a sudden and transient loss of consciousness and postural tone with spontaneous recovery without the assistance of a therapeutic intervention. It is estimated that the lifetime prevalence of syncope could reach approximately 50% of the general population. In the United States, it is estimated that one to two million patients are evaluated for syncope annually. This represents anywhere from three to five percent of all emergency room visits and one to six percent of all hospital admissions.
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Syncope: Perspectives on a Common Problem
Syncope is defined as the sudden loss of consciousness associated with the absence of postural tone, and is usually followed by a complete and rapid recovery. It is a very common clinical problem. The overall incidence of this first report of syncope is that it occurs in 6.2 per 1,000 patients; the incidence rate increases with age, especially after age 70.1 The estimated 10-year cumulative incidence of syncope is 6%, and up to 22% of patients experience recurrent syncope.
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A Study of Carotid Sinus Massage and Head-Up Tilt Table Testing in Patients with Syncope and Near-Syncope
Patients with syncope of unknown origin are commonly evaluated using several diagnostic tools. It has been suggested that there is a significant overlap between the results of head-up tilt table testing (HUT) and carotid sinus massage (CSM). We retrospectively studied the association between tilt table test results and CSM outcome in 136 patients with syncope or near-syncope who underwent both tests. Carotid sinus massage was performed prior to the tilt test, with the patient supine. The patient was then tilted to 60 degrees for up to 30 minutes. If this did not elicit a symptomatic abnormal hemodynamic response, the tilt was repeated for up to 30 minutes with intravenous isoproterenol.
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Syncope: Summarizing the 2006 AHA/ACCF Clinical Statement
Transient loss of consciousness, or syncope, is a common problem in medicine and a principal reason for electrophysiology evaluation. The cardiovascular system is implicated in most cases, but syncope can also result from non-cardiac causes as well. Ruling out life-threatening etiologies of syncope is the principal objective during the initial evaluation of syncope. The purpose of this review is to summarize the approach to the initial evaluation of syncope as proposed in a recent AHA/ACCF Scientific Statement.1
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The Utility of Implantable Loop Recorders for Diagnosing Unexplained Syncope in 100 Consecutive Patients ? Five-Year, Single-Center Experience
Introduction. The purpose of this study was to retrospectively review the 5-year experience of a university hospital with implantable loop recorders (ILR) for the diagnosis of recurrent, unexplained syncope or presyncope. Methods. One hundred patients with syncope or presyncope of unknown etiology (negative tilt-table test, electrophysiology study and neurologic workup) underwent prolonged monitoring with an ILR from March 2000 to December 2004. All implants were performed using a first-generation (manual activation) or second-generation (manual plus automatic activation) ILR. Results. One hundred patients (70 women, 30 men) with a mean age of 68 ± 18 years received the ILR. Twenty-three patients had coronary artery disease; 2 patients had dilated cardiomyopathy. Ten patients received a first-generation ILR, and 90 patients received a second-generation ILR. After 9 ± 8 months? follow up, ILR interrogation identified an arrhythmogenic etiology to the syncope/presyncope in 45 patients with 55 events. Eight patients had a diagnosis by ILR less than 2 months from the date of implantation. Twenty-six patients had documented symptomatic bradycardia (asystole, sinus pauses, atrial fibrillation with long pauses); 11 patients had episodes of sinus tachycardia with heart rates of 130?140 beats/minute; 2 patients had atrial tachycardia; 5 patients had multiple episodes of nonsustained ventricular tachycardia (NSVT); 1 patient had sustained ventricular tachycardia, and 4 patients had paroxysmal supraventricular tachycardia. All arrhythmias were treated successfully by pacemaker/ICD implantation, radiofrequency catheter ablation and/or medications. One patient had seizure activity, which was detected by ILR as high-frequency noise. Two patients failed to activate their device, as it was a first-generation device. Conclusion. Five-year experience with the ILR in 100 consecutive patients confirms the utility of this device in the diagnosis of recurrent, infrequent, unexplained syncope or presyncope.
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Syncope: Unleashing the Tiger
Welcome to the new ?EP 101? section of EP Lab Digest! In each of our upcoming issues, we will explore a basic topic in electrophysiology. In this month?s issue, Drs. Sandesara and Olshansky discuss a case in which the patient was experiencing multiple episodes of syncope. They describe which methods they used to diagnose and treat the patient, as well as explain common challenges one might encounter along the way.
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Initial Clinical Experience with Implantable Loop Recorders
The purpose of this study was to review the initial experience of a university hospital with Implantable Loop Recorders (ILR) for diagnosis of recurrent unexplained syncope or presyncope. Twelve patients with syncope or presyncope of unknown etiology (who had a negative tilt table test, electrophysiologic study, and neurologic work-up) underwent implantation of ILR. All implants were performed using the Reveal? ILR (Medtronic AVE, Santa Rosa, California). The 8 cc device is 61 mm long, 19 mm wide, 8 mm thick and weighs 17 grams. It has 18 months of battery life and has 2 electrodes with 38.5 mm spacing. The device is nonvascular and is implanted approximately 2 fingerbreadths below the clavicle in a subcutaneous pocket (1.5 inches long) and is secured via polydacron suture to the pre-pectoral fascia/pectoralis muscle.
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Book Review: The Fainting Phenomenon: Understanding Why People Faint and What to Do About It, Second Edition
In this article, Dr. Blair P. Grubb?s book, entitled The Fainting Phenomenon: Understanding Why People Faint and What to Do About It, Second Edition (ISBN: 9781405148412) is reviewed.
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Selective Use of Syncope Tests can Improve Diagnosis, Save Money, but Others not Convinced
Selective Use of Syncope Tests can Improve Diagnosis, Save Money, but Others not Convinced Industry News and Products: Selective Use of Syncope Tests can Improve Diagnosis, Save Money, but Others not Convinced - Responding to increased calls for better ways of diagnosing unexplained syncope, a Spanish research team has come up with a protocol involving selective use of electrophysiologic studies (EPSs), tilt-table tests (TTTs), and implantable loop recorders (ILRs). The debate over syncope ...
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For more information, contact them on the web at www.electropros.org. Heart Failure: Outpatient Management Helen Roth, RN, BS WakeMed Raleigh, North Carolina Helen Roth's presentation included the following: overview and scope of problems faced in heart failure, current trends in therapy, patient education, and key points. Tilt Table Trilogy Linda Sue Adams, MSN, ACNP, CRNP South Carolina Heart Center Columbia, South Carolina Syncope is a common clinical problem resulting...
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