Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry

Edvardsson, Nils; Frykman, Viveka; Mitro, Peter; Voulgaraki, Despina; Garutti, C; Stolt, Pelle; Linker, Nicholas J.; Saïd, M. Aït; Amman, Peter; Aronsson, T.; Bauer, Alexander; Benzer, W; Bernát, Vilam; Böcker, Dirk; Brandes, Axel; Breuls, P. N.; Buffler, Sébastien; Ebert, H; Ebrahimi, Ali; Eschen, Ole; Fåhraeus, Thomas; Falck, Geir; Fehske, Wolfgang; Frank, Robert; Gadler, F.; Gehling, Gisbert; Geist, Michael; Günther, Jens; Gutmann, Marc; Hartog, Hermien; Jensen, Steen M.; Kainz, W.; Kautzner, J.; Kiowski, W; Kjellman, Bengt; Klomps, Huub C.; Krappinger, H.; Lercher, Peter; Lindstrøm, Jonas Christoffer; Lukat, Michael; Macháčová, Z.; Magnusson, Carl; Maru, Fikru; Melichercik, Juraj; Militianu, Arie; Nemocnice, T. Minařίk; Mohii-Oskarsson, A.; Mølgaard, Henning; Nimeth, C.; Nordt, Thomas K.; Novák, Martin; Nyman, Kai; Pasquié, Jean‐Luc; Plomp, Jacobus; Podczeck-Schweighofer, Andrea; Ramanna, Hemanth; Rigollaud, J.-M.; Rorsman, Cecilia; Rotzer, A; Salo, Tiina; Samnieh, N.; Schwertfeger, F.; Strupp, Gerhard; Sunthorn, Henri; Trinks, Susanne; Gelder, I. C. Van; Mechelen, R. van; Ventura, Rodolfo; Vester, E. G.; Viskin, Sami; Visman, P.; Vlašínová, Jitka; Westbom, I.; Winkler, Winston; Woltmann, Jon

doi:10.1093/europace/euq418

Cited by 210 publications

(166 citation statements)

References 22 publications

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“…Diagnosis rates in the TC group are very similar to those described in previous studies (28% [11], 24% [12]) with similar populations. However, the lack of previous studies in the patient population from SC does not allow making any comparisons.…”

Section: Results Of the Ilrsupporting

confidence: 88%

“…The prevalence of structural heart disease in our population (30%) was similar to that in previous studies (28-33%), and so were the rest of baseline characteristics [11,12]. We did not find significant differences between patients from TCs and SCs.…”

Section: Discussionsupporting

confidence: 89%

“…The explanation for this could lie in a higher familiarity among TC physicians with this test, or a higher adherence to clinical guidelines. However, the rate of patients with CSM in both groups was higher to the one reported in previous studies (36% in the PICTURE Registry [11]) or in studies about syncope conducted in Emergency Units in Spain (0.4% in the GESINUR Study [13]). …”

Section: Diagnostic Testscontrasting

confidence: 70%

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Differences in the yield of the implantable loop recorder between secondary and tertiary centers

et al. 2015

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Section: Results Of the Ilrsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 89%

Section: Diagnostic Testscontrasting

confidence: 70%

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Differences in the yield of the implantable loop recorder between secondary and tertiary centers

et al. 2015

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“…4 The authors concluded that an ELR may be indicated for the initial screening of patients with recurrent unexplained syncope or presyncope in place of a more expensive ILR, which remains an option if, after 1 month, monitoring with an ELR has proven negative. 13 The International Study on Syncope of Uncertain Etiology (ISSUE-1) study showed that the majority of syncopal events documented with an ILR is likely to be neurally mediated, with asystolic pauses and reflex bradycardia being the most frequently associated rhythm disturbances.…”

Section: Loop Recorders In Syncope and Palpitationsmentioning

confidence: 99%

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Galli¹,

Ambrosini²,

Lombardi³

2016

Arrhythmia &Amp; Electrophysiology Review

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Since the 1960s, Holter monitoring has been a cornerstone for diagnosing suspected arrhythmias in patients of all ages. 1 The most common monitoring systems allow the continuous registration of three or more leads for 24-48 hours; newer Holter monitors allow continuous electrocardiogram (ECG) registration for 2 weeks.1 Extending the time of ECG registration will increase the diagnostic yield of Holter monitoring, especially for those rhythm disturbances that are infrequent but recurrent.1,2 This need for a prolonged ECG monitoring has been addressed by event recorders, which can monitor patients for up to 3 years, storing the ECG obtained a few minutes before and after the onset of an arrhythmia in its memory and transmitting data to the cardiac unit. 1,2 When interpreting the results of the ECG, the cardiologist has to determine whether symptoms reported by the patient could be linked to significant disturbances in heart rhythm.2 In other circumstances the detection of atrial or ventricular arrhythmias may alert the cardiologist, even if they occur asymptomatically, thus prompting a specific therapeutic decision such as starting antiarrhythmic or anticoagulant drugs or implanting a pacemaker or a cardioverter defibrillator. Cardiac Monitoring SystemsCardiac rhythm monitoring has an established diagnostic and prognostic role in different circumstances: syncope, palpitations and monitoring of patients with known or suspected episodes of atrial fibrillation (AF), e.g. those with stroke of uncertain aetiology (cryptogenic stroke).1-3 ECG monitoring may also play a role in identifying ventricular tachycardia (VT) in patients with recognised risk of sudden cardiac death. 4 As many devices with different characteristics are available, the choice of the most suitable monitoring system largely depends on the likelihood of detecting a significant correlation between symptoms and ECG findings. Holter MonitorsTraditional ambulatory Holter monitors are simple devices that usually have three leads and continuously register the ECG. They can be short-(24-48 hours) or long-duration (1-2 weeks) devices.1 Two-week Holter monitoring is preferred when diagnosing or excluding AF in cryptogenic stroke, but loop recorders and outpatient telemetry have even higher detection rates. Loop Recorders and Post-event RecordersNewer generation monitors are the so-called event recorders.According to their specific functions they can be divided into two categories: loop recorders, which include external loop recorders (ELRs) and implantable loop recorders (ILRs); and post-event recorders (non-looping recorders). 1 AbstractHolter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holt...

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“…For the most part ILRs have proven to be of greatest value in determining an arrhythmic basis for syncope, 1,2) and on occasion have been helpful in demonstrating that certain patients believed to be suffering from epilepsy, but whose symptoms are 'drug-refractory', may in fact be suffering from syncope.…”

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confidence: 99%

Subclinical Tonic-Clonic Epileptic Seizure Detected by an Implantable Loop Recorder

et al. 2013

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SummaryA 73-year old man received an implantable loop recorder (ILR) for the evaluation of transient loss of consciousness (TLOC) spells. His medical history was without any epileptic convulsions or automatism. ILR recording during a spontaneous episode revealed the presence of a regular, narrow QRS complex tachycardia associated with low-amplitude, high-frequency, continuous or discontinuous artifacts, consistent with myopotentials. During the event, the regular, lowamplitude continuous signals gradually became discontinuous, with a prolongation of the inter-signal cycle length, until their disappearance after manual activation of the ILR. The patient was diagnosed as experiencing subclinical tonic-clonic epileptic seizures. Antiepileptic drug treatment was initiated, and the patient has remained free of TLOC symptoms during 13 months follow-up. (Int Heart J 2013; 54: 289-291) Key words: Epilepsy, Syncope, Loss of consciousness T he implantable loop recorder (ILR) is a useful instrument for detection of heart rhythm disturbances in patients with transient loss of consciousness (TLOC) spells of unknown origin. For the most part ILRs have proven to be of greatest value in determining an arrhythmic basis for syncope, 1,2) and on occasion have been helpful in demonstrating that certain patients believed to be suffering from epilepsy, but whose symptoms are 'drug-refractory', may in fact be suffering from syncope.3) However, the ability of an ILR to unmask a seizure disorder in patients in whom the cause of TLOC is undetermined despite the usual investigations has been largely overlooked.Previous reports of ILR use in recurrent transient loss of consciousness (TLOC) in drug refractory epileptic patients have been published, and an association between ILR recorded myopotentials and clinically documented convulsive symptoms have been observed. 4,5) The present case describes a patient presenting with TLOC in the absence of apparent convulsions, in whom ILR monitoring detected myopotentials consistent with a subclinical epileptic seizure. Case ReportA 73-year-old man with a history of prior remote myocardial infarction and a 4-month-old hemorrhagic cerebral infarction was referred for evaluation of TLOC. The episode was characterized by sudden skin pallor followed by an abrupt fall onto the floor from a seating position in absence of convulsion. The episode lasted approximately 30 to 60 sec, and the patient regained consciousness immediately but sustained facial injuries from the fall. He denied having experienced palpitations or chest pain before or after the spell. His wife, who witnessed the episode, reported that the patient suddenly became pale and unresponsive to verbal stimuli; however, she did not observe any evidence of automatism or tonic-clonic movements. There was no report of epilepsy in the patient's family history.Blood pressure on admission was 114/82 mmHg and heart rate was 72 bpm and regular. A general physical examination and detailed neurologic assessment, including orthostatic vital signs, were ...

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Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry

Cited by 210 publications

References 22 publications

Differences in the yield of the implantable loop recorder between secondary and tertiary centers

Differences in the yield of the implantable loop recorder between secondary and tertiary centers

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Subclinical Tonic-Clonic Epileptic Seizure Detected by an Implantable Loop Recorder

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