Usefulness of the Implantable Loop Recorder to Detect Syncope in a Patient With Coronary Spastic Angina

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An 80-year-old man was urgently transported because of unconsciousness. On admission, the chest electrocardiogram showed a negative T-wave; there was a high possibility of cardiac syncope. No disorder was detected on coronary angiography or on cardiac electrophysiological study. Although he was diagnosed as having coronary spastic angina, a loop recorder was implanted because syncope didn’t occur during acetylcholine load test. Syncope occurred again, a loop recorder detected increasing ST elevation and atrioventricular junctional rhythm without high infrequent pulse or tachyarrhythmia. Decreased blood pressure and syncope due to Bezold-Jarisch reflex with coronary vasospasm was strongly suspected. With benidipine and nicorandil, he was discharged without recurrence of syncope for 3 years thereafter.