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The implantable loop recorder in children
1Department of Surgery, NHS Greater Glasgow & Clyde, Glasgow Royal Infirmary, Glasgow, UK.
Insights
The implantable loop recorder effectively diagnosed cardiac issues in children, resolving symptoms in nearly half of patients. It accurately identified arrhythmias in those with persistent syncope or palpitations.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Medical Devices
Background:
- Syncope and palpitations are common presenting complaints in pediatric cardiology.
- Accurate diagnosis of cardiac arrhythmias is crucial for effective management in children.
Purpose of the Study:
- To evaluate the utility and outcomes of implantable loop recorder (ILR) use in pediatric patients.
- To assess the diagnostic yield and complication rates of ILRs in children presenting with unexplained syncope, seizures, or palpitations.
Main Methods:
- A retrospective study was conducted on 34 children who received 38 ILR implantations between September 1998 and October 2005.
- Patient demographics, presenting complaints, diagnostic findings, symptom resolution, and complications were analyzed.
Main Results:
- The primary indications for ILR implantation were syncope (76.5%), seizures (17.6%), and palpitations (5.9%).
- Approximately 44.1% of patients experienced symptom resolution post-implantation.
- ILRs successfully identified cardiac rhythm during symptomatic episodes in patients with persistent symptoms, revealing conditions like asystole and ventricular tachycardia.
Conclusions:
- Implantable loop recorders are effective in achieving symptom resolution in nearly 50% of pediatric patients with syncope and palpitations.
- While diagnostic for persistent symptoms, the complication rate associated with ILR implantation in children may be higher compared to adults.
Objective:
To evaluate use of the implantable loop recorder in children.
Setting:
Royal Hospital for Sick Children, Glasgow, UK.
Method:
Retrospective study of children who had an implantable loop recorder between September 1998 and October 2005.
Results:
38 devices were implanted in 34 children. Median age at implantation 11.3 years (range 1.8-17.6); median follow-up period 15 months (range 2-58). The main presenting complaint was syncope in 26 (76.5%), seizures in 6 (17.6%) and palpitations in 2 (5.9%). After implantation, 19 (55.9%) patients had symptom recurrence. Of these, 11 were shown to have sinus rhythm during symptoms and 8 had an abnormal ECG. Four patients had asystole >3 seconds and were diagnosed with reflex asystolic syncope; 2 had polymorphic ventricular tachycardia. One patient who already had a diagnosis of long QT syndrome was shown to have ventricular ectopy during symptoms and beta-blockers were increased. One patient had transient complete heart block during symptoms but refused a pacemaker. In almost half the patients (44.1%), symptoms resolved after implantation. Complications requiring removal of the device occurred in 6 (15.8%) implants.
Conclusions:
In children with syncope and palpitations, the implantable loop recorder appears to be an excellent method of effecting a "cure" in almost 50% of subjects. For those who remain symptomatic, it is successful in determining cardiac rhythm during symptoms, but the complication rate in children may be higher than that of adults.
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