Pacemaker Implantation Based on AmbulatoryECG Monitoring in Patients with Cerebral Symptoms· Dan Tzivoni, M.D., and Shlomo Stern, M.D.
Continuous ambulatory ECG monitoring was perfonned in 110 patients because of a bistory of dizziness, aHeged
syncope or vague cerebral manifestations. The resting ECG failed to provide an explanation for symptoms in any of tbe patients. In 12 patients the monitoring revealed a variety of arrhytbmic mechanisms wbicb required pacemaker implantation. Five of these patients
patients suffering from dizziness and loss of consciousness frequently present a diagnostic problem. The underlying disease may be vestibular, cerebral or cardiac, and the differentiation is frequently difficult. Among the cardiac causes, brady- and tachyarrhythmias, and various degrees of atrioventricular (A-V) block are the most commoD. These may cause similar symptoms, although they have different mechanisms and may require different treatment. Their detection is difficult if the resting ECG provides no hint of such abnormalities. Continuous electrocardiographic monitoring in ambulatory patients has been used for detection of transient arrhythmias. l -3 In this study we report our experience with this method in solving the diagnostic problem in patients with various cerebral manifestations. The 12 patients described here suffered from episodes of dizziness and syncope, and the .continuous ambulatory ECG monitoring revealed various degrees of A-V block, sinoatrial (SA) block, and/ or sick sinus syndrome (SSS), leading to pacemaker implantation. PATIENTS AND METHODS
During a two-year period 600 patients underwent continuous ECG monitoring by the Holter meth
Continuous ambulatory ECG monitoring was perfonned in 110 patients because of a bistory of dizziness, aHeged
syncope or vague cerebral manifestations. The resting ECG failed to provide an explanation for symptoms in any of tbe patients. In 12 patients the monitoring revealed a variety of arrhytbmic mechanisms wbicb required pacemaker implantation. Five of these patients
patients suffering from dizziness and loss of consciousness frequently present a diagnostic problem. The underlying disease may be vestibular, cerebral or cardiac, and the differentiation is frequently difficult. Among the cardiac causes, brady- and tachyarrhythmias, and various degrees of atrioventricular (A-V) block are the most commoD. These may cause similar symptoms, although they have different mechanisms and may require different treatment. Their detection is difficult if the resting ECG provides no hint of such abnormalities. Continuous electrocardiographic monitoring in ambulatory patients has been used for detection of transient arrhythmias. l -3 In this study we report our experience with this method in solving the diagnostic problem in patients with various cerebral manifestations. The 12 patients described here suffered from episodes of dizziness and syncope, and the .continuous ambulatory ECG monitoring revealed various degrees of A-V block, sinoatrial (SA) block, and/ or sick sinus syndrome (SSS), leading to pacemaker implantation. PATIENTS AND METHODS
During a two-year period 600 patients underwent continuous ECG monitoring by the Holter meth
