The diagnostic yield of implantable loop recorders stratified by indication: “real-world” use in a large academic hospital

Smith, Alice L.; Perdue, Makenzie; Vojnika, Jetmir; Frisch, Daniel R.; Pavri, Behzad B.

doi:10.1007/s10840-020-00815-w

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…Indeed, in this study, all devices were implanted in an outpatient setting by nurse practitioners. The distribution of indications was also in keeping with that of previous studies [8][9][10] . However, it is striking that whereas in a quarter of patients over the age of 75 a treatment recommendation of pacemaker implant was made, in only two patients under the age of 40 did device implantation occur.…”

Section: ) Ilr Implantation Only Rarely Changes the Management Or Dia...supporting

confidence: 88%

The utility of implantable loop recorders in patient management: an age- and indication-stratified study in the outpatient-implant era

Sanghvi

Jones

Kalindjian

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

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Introduction Implantable loop recorders (ILR) are now routinely implanted for long-term cardiac monitoring in the clinic setting. This study examined the real-world performance of these devices, focusing on the management decision changes made in response to ILR-recorded data. Methods and Results This was a single centre, prospective observational study of consecutive patients undergoing ILR implantation. All patients who underwent implantation of a Medtronic Reveal LINQ device from September 2017 to June 2019 at Barts Heart Centre were included. 501 patients were included. 302 (60%) patients underwent ILR implantation for an indication of pre-syncope/syncope, 96 (19%) for palpitations, 72 (14%) for atrial fibrillation (AF) detection with a history of cryptogenic stroke and 31 (6%) for patients deemed to be high risk of serious cardiac arrhythmia. The primary outcome of this study was that an ILR-derived diagnosis altered management in 110 (22%) of patients. Secondary outcomes concerned sub-group analyses by indication: in patients who presented with syncope/presyncope, a change in management resulting from ILR data was positively associated with age (HR: 1.04 [95%CI 1.02–1.06]; p < 0.001) and negatively associated with a normal ECG at baseline (HR 0.54 [0.31–0.93]; p = 0.03). Few patients (1/57, 2%) aged < 40 years in this group underwent device implantation, compared to 19/62 patients (31%) aged 75 years and over (p = 0.0024). 22/183 (12%) of patients in the 40–74 age range had a device implanted. In patients who underwent ILR insertion following cryptogenic stroke, 13/72 patients (18%) had AF detected leading to a decision to commence anticoagulation. Conclusion These results inform the utility of ILR in the clinical setting. Diagnoses provided by ILR that lead to changes in management are rare in patients under age 40, particularly following syncope, presyncope or palpitations. In older patients new diagnoses are frequently made and trigger important changes in treatment.

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Section: ) Ilr Implantation Only Rarely Changes the Management Or Dia...supporting

confidence: 88%

The utility of implantable loop recorders in patient management: an age- and indication-stratified study in the outpatient-implant era

Sanghvi

Jones

Kalindjian

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

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show abstract

“…In clinical practice, an ILR is mainly used in patients with unexplained syncope. 13 14 22 This is not surprising considering the unique feature of an ILR to automatically record the rhythm during a syncopal event. For this purpose, conventional Holters or event recorders are less suitable considering the infrequent nature of the events.…”

Section: Discussionmentioning

confidence: 99%

“… 14 Another single-centre cohort study by Smith et al also demonstrated a higher diagnostic yield of the ILR in patients with palpitations in comparison to patients with syncope (60% vs 28%). 13 Both studies mainly comprised patients with a structural normal heart. Our study extends these findings to patients with structural and electrical heart disease by demonstrating no difference in actionable events between symptomatic patients with and without syncope.…”

Section: Discussionmentioning

confidence: 99%

“… 9–12 However, there is limited data on the yield of an ILR based on the presence or absence of a history of syncope. 13 14 Furthermore, limited studies have focused on patients with structural or electrical heart disease. The aim of the present study is to compare the actionable event rate between symptomatic patients with a structural or electrical heart disease who present with and without a history of syncope.…”

Section: Introductionmentioning

confidence: 99%

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Implantable loop recorders in patients with heart disease: comparison between patients with and without syncope

et al. 2021

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ObjectivePatients with heart disease are at increased risk for sudden cardiac death. Guidelines recommend an implantable loop recorder (ILR) for symptomatic patients when symptoms are sporadic and possibly arrhythmia-related. In clinical practice, an ILR is mainly used in patients with unexplained syncope. We aimed to compare the clinical value of an ILR in patients with heart disease and a history of syncope versus those with non-syncopal symptoms.MethodsIn this observational single-centre study, we included symptomatic patients with heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to device implantation.ResultsOne hundred and twenty patients (mean age 47±17 years, 49% men) were included. The underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%) and other (18%). Group A consisted of 43 patients with prior syncope and group B consisted of 77 patients with palpitations and/or near-syncope. The median follow-up duration was 19 months (IQR 8–36). The 3-year cumulative event rate was similar between groups with regard to the primary endpoint (38% vs 39% for group A and B, respectively, logrank p=0.54). There was also no difference in the 3-year cumulative rate of device implantation (21% vs 13% for group A and B, respectively, logrank p=0.65).ConclusionIn symptomatic patients with heart disease, there is no difference in the yield of an ILR in patients presenting with or without syncope.

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“…The most crucial part of each implanted device is the integrated antenna. Because of the small package requirement, small planar antennas are considered to be the best candidates for medical implantable applications because of their thin profile [137]. Different research studies have investigated the integration of patch and planar inverted-F antennas (PIFA) [138], [139].…”

Section: B Implantable Wireless Body Area Networkmentioning

confidence: 99%

A Review on the State of the Art in Atrial Fibrillation Detection Enabled by Machine Learning

Rizwan

Zoha

Mabrouk

et al. 2021

IEEE Rev. Biomed. Eng.

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Atrial Fibrillation (AF) the most commonly occurring type of cardiac arrhythmia is one of the main causes of morbidity and mortality worldwide. The timely diagnosis of AF is an equally important and challenging task because of its asymptomatic and episodic nature. n this paper, state-ofthe-art ECG data-based machine learning models and signal processing techniques applied for auto diagnosis of AF are reviewed. Moreover, key biomarkers of AF on ECG and the common methods and equipment used for the collection of ECG data are discussed. Besides that, the modern wearable and implantable ECG sensing technologies used for gathering AF data are presented briefly. In the end, key challenges associated with the development of auto diagnosis solutions of AF are also highlighted. It is the first review paper of its kind that comprehensively presents a discussion on all these aspects related to AF auto-diagnosis at one place. It is observed that there is dire need of low energy, low cost but accurate auto diagnosis solutions for the proactive management of AF.

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The diagnostic yield of implantable loop recorders stratified by indication: “real-world” use in a large academic hospital

Cited by 9 publications

References 17 publications

The utility of implantable loop recorders in patient management: an age- and indication-stratified study in the outpatient-implant era

The utility of implantable loop recorders in patient management: an age- and indication-stratified study in the outpatient-implant era

Implantable loop recorders in patients with heart disease: comparison between patients with and without syncope

A Review on the State of the Art in Atrial Fibrillation Detection Enabled by Machine Learning

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