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Implantable loop recorders in pediatric practice
Beatrijs L P Bloemers1, Narayanswami Sreeram
1Department of Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
The implantable loop recorder (ILR) effectively diagnoses recurrent syncope and palpitations in children when other tests fail. This device provides a definitive diagnosis, enabling timely and appropriate treatment for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
Background:
- Recurrent syncope and palpitations are common in children, posing diagnostic challenges.
- Conventional cardiovascular testing is often inconclusive in these pediatric cases.
- The role of implantable loop recorders (ILRs) in pediatric practice requires further definition.
Purpose of the Study:
- To evaluate the diagnostic yield of implantable loop recorders (ILRs) in children and young adults.
- To determine the effectiveness of ILRs in diagnosing unexplained syncope and palpitations in pediatric patients.
Main Methods:
- A review of seven pediatric patients (mean age 12.8 years) who underwent ILR implantation.
- Indications included syncope, near-syncope, palpitations, and acute life-threatening events.
- Previous inconclusive testing included ECG, echocardiography, Holter monitoring, and electrophysiologic studies.
Main Results:
- Four out of seven patients (57%) experienced persistent symptoms during a mean follow-up of 7.5 months.
- The implantable loop recorder (ILR) successfully established the correct diagnosis in all patients.
- Diagnosis facilitated appropriate therapeutic interventions.
Conclusions:
- The implantable loop recorder (ILR) is a valuable tool for diagnosing recurrent syncope and palpitations in children and young adults.
- ILR utilization can lead to definitive diagnoses and guide effective treatment strategies in pediatric cardiology.
- Further studies are warranted to solidify the role of ILRs in pediatric electrophysiology.
Abstract:
Symptoms of syncope and palpitations are not uncommon in children with and without heart disease. They present a diagnostic dilemma when conventional cardiovascular testing is inconclusive. The implantable loop recorder (ILR) has been shown to play an important role in diagnosing recurrent syncope in adult patients. In pediatric practice its role still has to be defined. The aim of this review is to assess the diagnostic yield of the ILR in children and young adults. Seven patients, 4 male and 3 female, were included in the study. Mean age at implantation was 12.8, range 0.8 to 25.9. Indications for ILR were syncope (N=6), near-syncope (N=1), palpitations (N=2) and acute life threatening event (N=2). Previous testing included 12-lead ECG (N=7), echo (N=7), 24 hour Holter (N=7), 4 week ambulatory Holter (N=3), exercise test (N=4) and invasive electrophysiologic study (N=3). Over a mean follow-up period of 7.5 months (range 3 to 16 months), 4 (57%) patients continued to have symptoms. The ILR enabled the correct diagnosis to be established in all, allowing for appropriate therapy.
