Syncope is a concerning symptom that affects a large proportion of patients.It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death.However,be...Syncope is a concerning symptom that affects a large proportion of patients.It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death.However,benign causes are the most frequent,and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis,initiate effective therapy,and alter the prognosis.The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder,while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders.Indeed,arrhythmias are the most common cause of cardiac syncope.Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope.In this review,we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin.Therefore,we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients,risk stratification,and the management of syncope in different scenarios such as structural heart disease and channelopathies.展开更多
Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although the...Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although there are otheretiologies. For diagnosis, it is essential to be able to reliably correlate the symptomswith an electrocardiographic record allowing the identification or rulingout of a possible rhythm disorder. However, reaching a diagnosis is not alwayssimple, given that they tend to be transitory symptoms and the patient isfrequently asymptomatic at the time of assessment. In recent years, electrocardiographicmonitoring systems have incorporated many technical improvements thatsolve several of the 24-h Holter monitor limitations. The objective of this review isto provide an update on the different monitoring methods currently available,remarking their indications and limitations, to help healthcare professionals toappropriately select and use them in the work-up of patients with palpitations.展开更多
<em>Objective</em>: To evaluate feasibility of MRI in patients with non-pacemaker (PM)/Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. <em>Background</em>: Re...<em>Objective</em>: To evaluate feasibility of MRI in patients with non-pacemaker (PM)/Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. <em>Background</em>: Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. <em>Methods</em>: We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes. <em>Results</em>: The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190 ± 475 days (median 13 days). No device malfunction was reported during follow-up. <em>Conclusions</em>: With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.展开更多
文摘Syncope is a concerning symptom that affects a large proportion of patients.It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death.However,benign causes are the most frequent,and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis,initiate effective therapy,and alter the prognosis.The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder,while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders.Indeed,arrhythmias are the most common cause of cardiac syncope.Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope.In this review,we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin.Therefore,we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients,risk stratification,and the management of syncope in different scenarios such as structural heart disease and channelopathies.
文摘Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although there are otheretiologies. For diagnosis, it is essential to be able to reliably correlate the symptomswith an electrocardiographic record allowing the identification or rulingout of a possible rhythm disorder. However, reaching a diagnosis is not alwayssimple, given that they tend to be transitory symptoms and the patient isfrequently asymptomatic at the time of assessment. In recent years, electrocardiographicmonitoring systems have incorporated many technical improvements thatsolve several of the 24-h Holter monitor limitations. The objective of this review isto provide an update on the different monitoring methods currently available,remarking their indications and limitations, to help healthcare professionals toappropriately select and use them in the work-up of patients with palpitations.
文摘<em>Objective</em>: To evaluate feasibility of MRI in patients with non-pacemaker (PM)/Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. <em>Background</em>: Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. <em>Methods</em>: We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes. <em>Results</em>: The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190 ± 475 days (median 13 days). No device malfunction was reported during follow-up. <em>Conclusions</em>: With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.
