Objective To investigate the value of implantable cardiac monitor(ICM)in the diagnosis and treatment of patients over 60 years old with unexplained syncope.Methods This was a multi-center,prospective cohort study.Between June 2018 and April 2021,patients over the age of 60 with unexplained syncope at Beijing Hospital,Fuwai Hospital,Beijing Anzhen Hospital and Puren Hospital were enrolled.Patients were divided into 2 groups based on their decision to receive ICM implantation(implantation group and conventional follow-up group).The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up.Kaplan-Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups.A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.Results A total of 198 patients with unexplained syncope,aged(72.9±8.25)years,were followed for 558.0(296.0,877.0)d,including 98 males(49.5％).There were 100(50.5％)patients in the implantation group and 98(49.5％)in the conventional follow-up group.Compared with conventional follow-up group,patients in the implantation group were older,more likely to have comorbidities,had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram,and had a lower body mass index(all P＜0.05).During the follow-up period,positive cardiac arrhythmia events were recorded in 58(58.0％)patients in the ICM group.The diagnosis rate(42.0％(42/100)vs.4.1％(4/98),P＜0.001)and the intervention rate(37.0％(37/100)vs.2.0％(2/98),P＜0.001)of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group(all P＜0.001).Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group(HR=11.66,95％CI 6.49-20.98,log-rank P＜0.001).Multivariate analysis indicated that ICM implantation,previous atrial fibrillation,diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope(all P＜0.05).Conclusions ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope,and increases diagnostic efficiency in patients with unexplained syncope.
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