Christian Meyer, Paulo Carvalho, Christoph Brinkmeyer, Malte Kelm, Ricardo Couceiro, Jens Mühlsteff
Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany
Med Sci Monit 2015; 21:276-282
Syncope is a common disorder with a lifetime prevalence of about 40%. Implantable cardiac electronic devices, including implantable loop recorders (ILR) and implantable cardioverter-defibrillators (ICD), are well established in syncope management. However, despite the successful use of ILR and ICD, diagnosis and therapy still remain challenging in many patients due to the complex hemodynamic interplay of cardiac and vascular adaptations during impending syncopes. Wearable sensors might overcome some limitations, including misdiagnosis and inappropriate defibrillator shocks, because a variety of physiological measures can now be easily acquired by a single non-invasive device at high signal quality. In neurally-mediated syncope (NMS), which is the most common cause of syncope, advanced signal processing methodologies paved the way to develop devices for early syncope detection. In contrast to the relatively benign NMS, in arrhythmia-related syncopes immediate therapeutical intervention, predominantly by electrical defibrillation, is often mandatory. However, in patients with a transient risk of arrhythmia-related syncope, limitations of ICD therapy might outweigh their potential therapeutic benefits. In this context the wearable cardioverter-defibrillator offers alternative therapeutical options for some high-risk patients. Herein, we review recent evidence demonstrating that wearable sensors might be useful to overcome some limitations of implantable devices in syncope management.
Keywords: Arrhythmias, Cardiac - diagnosis, Algorithms, Death, Sudden - prevention & control, Defibrillators, Implantable, Equipment Design, Hemodynamics, Miniaturization, Monitoring, Ambulatory - methods, Neurons - pathology, Prevalence, Prostheses and Implants, Syncope - therapy