Usefulness of Implantable Loop Recorder in a Patient with Syncope during Bathing

概要

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A 27-year-old man was seen in the cardiology department of our hospital because of syncope. Repeated syncope occurred especially during bathing or on a hot day since one year ago. Baseline ECG revealed no abnormality and no organic heart disease was detected by echocardiogram. Holter recording showed no ventricular event or any bradycardia. Tilt test could not induce any bradycardia, however, blood pressure decreased by 39 mmHg (no symptom). Neutrally-mediated syncope (vasoinhibitory type) was mostly suspected at this time. Since no bradycardia/tachycardia including ventricular arrhythmia was induced on electrophysiological study, implantable loop recorder (ILR) was implanted. After 2 months he had syncope when he took a bath at midnight. Though he almost drowned in the bathtub, his family rescued him successfully. In a meanwhile his consciousness recovered completely. He did not have any sequelae at all. Sinus arrest and a maximum ventricular pause of 10.2 seconds were documented with ILR during this syncopal attack. He was treated with a permanent pacemaker implantation. The changes of blood pressure and heart rate during taking bath are quite complicated. While ordinary Holter recording can not be used in a bathroom, ILR can work even in this situation. ILR has much possibility to detect a cause of syncopal attack even in the cases with repeated syncope during bathing.