The evidence for the implantable loop recorder in patients with inherited arrhythmia syndromes: a review of the literature

Balfe, Christopher; Durand, Rory; Crinion, Derek; Ward, Deirdre; Sheahan, Richard G.

doi:10.1093/europace/euab256

Cited by 17 publications

(5 citation statements)

References 23 publications

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“…Our study is in tune with previous data that showed that ILRs are a strategic tool to guide management and reassure patients and physicians [14][15]. The increase in the use of this technology over recent years is also re ected in our data: our institution has doubled the ILR implantations during the last 5 years when compared both to previous practice and literature (Kenny et al).…”

Section: Discussionsupporting

confidence: 86%

Implantable loop recorders in the diagnosis and management of cardiac symptoms in children and adolescents

Agudo-Montore,

Stuart,

Wilson

et al. 2023

Preprint

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Implantable loop recorders (ILR) have emerged as long-term effective monitoring tools for severe or recurrent rhythm abnormalities or unexplained cardiac symptoms. Scarce information is available on the use and results of this technology in the pediatric age. Report of the results of a cohort of pediatric patients that benefited from ILR implantation. Retrospective chart review of clinical data, implantation indications, diagnostic recordings and changes in patient management in pediatric patients who underwent Reveal LINQ ILR implantation from January 2016 to February 2022 at a single pediatric cardiology department in a tertiary care children’s hospital. In a pediatric cohort of 155 patients (mean age at implantation 10.3 years), 98 patients (63%) had ILR transmissions, 41 (42%) of which demonstrated a diagnostic arrhythmia recording. The median time to a diagnostic transmission was 175 days. The most common abnormality was sinus pauses (37%), followed by ventricular tachycardia (30%). Of the total transmissions, 78 (80%) were patient-activated and 21% of them had pathological traces. From the device-activated transmission (n=33, 34%), 79% showed pathological tracings. Some of the transmissions were simultaneously patient and device-activated. In 80% of patients with an ILR-related diagnosis, there was an arrhythmia management plan change including medication change, a pacemaker or an implantable cardioverter defibrillator implantation, and an indication to perform an electrophysiology study. No major complications occurred; 4 patients (2.4%) had minor complications. ILRs have emerged as a new technology proven to be effective and safe in diagnosing and managing pediatric arrhythmias.

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Section: Discussionsupporting

confidence: 86%

Implantable loop recorders in the diagnosis and management of cardiac symptoms in children and adolescents

Agudo-Montore,

Stuart,

Wilson

et al. 2023

Preprint

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show abstract

“…The present study has certain limitations that should be acknowledged. Firstly, the small sample size might have limited the precision of the estimates and the inclusion of patients with not fully established indications for ICM, such as structural heart disease or with arrhythmic inherited diseases 29 . Secondly, the retrospective design could have introduced potential inaccuracies in the data collected from medical records and resulted in a lack of detailed information on treatment decisions following arrhythmic diagnoses, potentially affecting the assessment of clinical relevance.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, the small sample size might have limited the precision of the estimates and the inclusion of patients with not fully established indications for ICM, such as structural heart disease or with arrhythmic inherited diseases. 29 Secondly, the retrospective design could have introduced potential inaccuracies in the data collected from medical records and resulted in a lack of detailed information on treatment decisions following arrhythmic diagnoses, potentially affecting the assessment of clinical relevance. Furthermore, we did not assess a possible association of SARS-CoV-2 infection with arrhythmic findings as described in previous studies that investigated the impact of COVID-19 on arrhythmic events.…”

Section: Study Limitationsmentioning

confidence: 99%

Incidental and anticipated arrhythmic diagnoses in patients with an implantable cardiac monitor

Maines,

Rotondi,

Guarracini

et al. 2024

Journal of Cardiovascular Medicine

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Aims In this study, we investigated a cohort of unselected patients with various indications for an implantable cardiac monitor (ICM). Our main objectives were to determine the incidence of arrhythmic diagnoses, both anticipated and incidental in relation to the ICM indication, and to assess their clinical relevance. Methods We examined remote monitoring transmissions from patients with an ICM at four Italian sites to identify occurrences of cardiac arrhythmias. Concurrently, we collected data on medical actions taken in response to arrhythmic findings. Results The study included 119 patients, with a median follow-up period of 371 days. ICM indications were syncope/presyncope (46.2%), atrial fibrillation management (31.1%), and cryptogenic stroke (22.7%). In the atrial fibrillation management group, atrial fibrillation was the most common finding, with an incidence of 36% [95% confidence interval (CI) 22–55%] at 18 months. Rates of atrial fibrillation were not significantly different between patients with cryptogenic stroke and syncope/presyncope [17% (95% CI 7–40%) vs. 8% (95% CI 3–19%), P = 0.229]. For patients with cryptogenic stroke, the incidence of asystole and bradyarrhythmias at 18 months was 23% (95% CI 11–45%) and 42% (95% CI 24–65%), respectively, similar to estimates obtained for patients implanted for syncope/presyncope (P = 0.277 vs. P = 0.836). Overall, 30 patients (25.2%) required medical intervention following ICM-detected arrhythmias, predominantly involving atrial fibrillation ablation (10.9%) and medication therapy changes (10.1%). Conclusion In a real-life population with heterogeneous insertion indications, approximately 25% of patients received ICM-guided medical interventions within a short timeframe, including treatments for incidental findings. Common incidental arrhythmic diagnoses were bradyarrhythmias in patients with cryptogenic stroke and atrial fibrillation in patients with unexplained syncope.

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“…Recent guidelines acknowledge consideration of the ILR to out rule malignant arrhythmia as a cause of syncope in certain inherited arrhythmia patients at low risk of sudden cardiac death. 76 …”

Section: Diagnostic Workup For Syncope Aetiology: Summary Of 25 Years...mentioning

confidence: 99%

Twenty-five years of research on syncope

Fedorowski,

Kulakowski,

Brignole

et al. 2023

Europace

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Over the last 25 years, the Europace journal has greatly contributed to dissemination of research and knowledge in the field of syncope. More than 400 manuscripts have been published in the journal. They undoubtedly improved our understanding of syncope. This symptom is now clearly differentiated from other forms of transient loss of consciousness. The critical role of vasodepression and/or cardioinhibition as final mechanisms of reflex syncope is emphasized. Current diagnostic approach sharply separates between cardiac and autonomic pathways. Physiologic insights have been translated, through rigorously designed clinical trials, into non-pharmacological or pharmacological interventions and interventional therapies. The following manuscript is intended to give the reader the current state of the art of knowledge of syncope by highlighting landmark contributions of the Europace journal.

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The evidence for the implantable loop recorder in patients with inherited arrhythmia syndromes: a review of the literature

Cited by 17 publications

References 23 publications

Implantable loop recorders in the diagnosis and management of cardiac symptoms in children and adolescents

Implantable loop recorders in the diagnosis and management of cardiac symptoms in children and adolescents

Incidental and anticipated arrhythmic diagnoses in patients with an implantable cardiac monitor

Twenty-five years of research on syncope

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