Efficacy of Implantable Loop Recorders in Establishing Symptom-Rhythm Correlation in Young Patients With Syncope and Palpitations

Abstract

ABSTRACT. Objective. To evaluate efficacy of the recently introduced implantable loop recorder (ILR) in establishing symptom-rhythm correlation in young patients with syncope, near syncope, palpitations, and acute life-threatening events (ALTEs).Methods. A retrospective study was conducted with patients with ILR from 3 pediatric centers. Inclusion criteria were age <25 years and a minimum follow-up of 1 month. All ILR-stored events were analyzed regularly for the presence or absence of an arrhythmia at the time of the symptomatic event.Results. Twenty-one patients (12 male, 9 female) with an average age of 12.3 ؎ 5.3 years (range: 0.8 -22 years) were included in the study. Five (24%) patients had structural heart disease, 2 (10%) had a family history of sudden cardiac death, 3 (14%) had QT prolongation on electrocardiogram, and 11 had no cardiovascular disease. Indications for ILR were recurrent syncope and near syncope (n ‫؍‬ 15), palpitations (n ‫؍‬ 2), and ALTE (n ‫؍‬ 2). Fourteen (67%) patients continued to have symptoms, and 7 (33%) had no symptoms after ILR over a follow-up period of 8.4 ؎ 4.7 months (range: 1.9 -16 months). Symptom-rhythm correlation was possible in all 14 patients who continued to have symptoms (supraventricular tachycardia in 4, ventricular tachycardia in 2, torsades de points in 1, asystole in 1, junctional bradycardia in 1, and sinus rhythm in 5).Conclusions. ILR is useful in determining the presence or absence of an arrhythmia during symptoms of syncope, near syncope, and palpitations as well as ALTEs in patients with and without structural heart disease when conventional diagnostic testing, such as electrocardiogram, Holter monitoring, and/or external loop recording, is inconclusive. Pediatrics 2003;112:e228 -e233. URL: http://www.pediatrics.org/cgi/content/full/112/3/e228; implantable loop recorder, arrhythmias, syncope, palpitations.

Digital implantable loop recorders in the investigation of syncope in children: Benefits and limitations

“…This cause often is diagnosed by a detailed history alone, but differentiation from arrhythmogenic causes based on history alone can be difficult. Symptoms may be mimicked using a head-up tilt table test 7 ; however, this test has poor specificity and sensitivity. Twelve-lead ECG is valuable for detecting some cases of long QT syndrome, Brugada syndrome, or Wolff-Parkinson-White syndrome.…”

Tekrarlayan Senkop Atağı Olan Bir Çocuk Hastada Ventriküler Taşikardinin İmplantable Loop Recorder ile Saptanması

“…Çocuklarda ILR kullanımı ile ilgili küçük bir seri çalışması ve birkaç olgu sunumu bulunmaktadır (4)(5)(6)(7)(11)(12)(13)(14). ILR'nin tanıdaki faydası kıyaslandığında az sayıdaki çocuk çalışmasında %50, yetişkin çalışmalarında ise %95 gibi yüksek bir değer bulunmuştur (5)(6)(7)(8)11). ILR kullanmada hasta seçimi, yüksek tanısal fayda sağlamak için son derece önemlidir.…”

“…Senkop ile gelen hastada tanıda bir sonraki adım elektrokardiyografi (EKG), ekokardiyografi (EKO), Holter monitorizasyonu, efor testi ve bazen eğik masa testi gibi testlerin yapılıp değerlendirilmesidir. Özellikle yapısal kalp hastalığı olan hastalarda aritmi kardiyak senkop yapabilir, bu hastalarda girişimsel elektrofizyolojik çalışma veya kateter ablasyon gerekebilir (4,5). Ancak tüm bu tanı testlerine rağmen senkop mekanizması açıklanamayabilir.…”

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

“…[53][54][55][56][57][58][59] Most frequently complaints are associated with normal sinus rhythm or neurally mediated sinus bradycardia, especially when there is no history of congenital or acquired heart disease. [58][59] These findings provide reassurance of the benign nature of some symptoms.…”

“…In cases where a clinically significant or lifethreatening arrhythmia is diagnosed with the ILR, a specific therapy is generally required, such as the implantation of an ICD, a pacemaker, transcatheter ablation or drug therapy. 58,59 ILRs have been effectively implanted in children under 1 year of age 53,54 and may have a higher diagnostic yield than ELRs, especially in younger children, as they do not have any external wearable part and …”