Early versus delayed implantation of a loop recorder in patients with unexplained syncope — Effects on care pathway and diagnostic yield

Ambulatory diagnostic ECG monitoring for syncope and collapse: An assessment of clinical practice in the United States

“…In brief, and not surprisingly, the findings indicate that longer‐term loop recorders (generally up to 1 month) provide superior diagnostic capability . Similarly, ICMs, by virtue of offering even more prolonged ambulatory monitoring than do event monitors, have been shown to provide greater diagnostic effectiveness than do wearable loop recorders in this setting . Further, ICMs have proven particularly valuable when conventional diagnostic strategies have failed.…”

“…3,[12][13][14][15] Similarly, ICMs, by virtue of offering even more prolonged ambulatory monitoring than do event monitors, have been shown to provide greater diagnostic effectiveness than do wearable loop recorders in this setting. 12,[16][17][18][19][20][21] Further, ICMs have proven particularly valuable when conventional diagnostic strategies have failed. For example, the PICTURE registry assessed the diagnostic utility of ICMs in 570 patients considered to have presyncope (7%) or syncope (91%) of unexplained cause.…”

Diagnostic and therapeutic value of implantable loop recorder: A tertiary care center experience

“…ILR implantation has been reviewed and evaluated in a variety of clinical situations, including unexplained syncope, palpitations, and other presentations that could suggest an arrhythmic cause . Prior data have suggested that early rather than late implantation of ILR in patients undergoing evaluation for syncope helps in the reduction of hospitalization and morbidity (53% vs 75%, P value < 0.001) …”

Management of syncope: from evidence to clinical practice

“…Relapse's rate and syncopal events' recurrence (that is to say number of T-LOC per year) and ECG-graphics alterations, such as a bundle branch block, have a high positive predictive value regarding on syncope incidence, so there are useful factors for patients' selection. 7 Conversely age, sex, positive response to the tilt test and presentation's severity of loss of consciousness have a low predictive value. 8 The ILR is a valuable weapon for the definitive diagnosis of syncope; it can be used in patients with block bundle where it is highly able to document a paroxysmal atrial ventricular (AV) block, in patients with structural heart disease but with negative cardiac evaluation, in individuals with documented carotid sinus hypersensitivity, in pediatric patients, or in patients with probable neurally mediated syncope diagnosis after initial assessment.…”

“…14,15 The question about the ILR implantation proper timing remains open entirely; if this device was initially considered a last resort option and reserve diagnostic once other investigative weapons were exhausted, now various evidence indicates a potential role of this early. 7 In conclusion, according to the European Society of Cardiology (ESC) 2009 guidelines the ILR implantation is indicated with Class 1 and evidence A: i) in patients with recurrent and uncertain origin syncope after initial assessment to exclude high risk factors presence such as severe structural heart disease and coronary important comorbidities, family history of sudden cardiac death, inadequate sinus bradycardia, BBB, abnormal QT or ventricular repolarization, preceded by palpitations or syncope occurred in the supine position or even during exercise in early stage; ii) in patients with both high likelihood of syncope recurrence (at least three syncopal episodes in the previous two years with interval between the first and the last event of at least 6 months) within the operating time of the device's battery; iii) in high-risk patients in whom complete evaluation has not led to diagnosis or did not lead to specific treatment.…”