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A retrospective study of the clinical experience of the implantable loop recorder in a paediatric setting
1Cardiac Arrhythmia Department, St Vincent's University Hospital, Dublin, Ireland.
Insights
The implantable loop recorder (ILR) effectively diagnoses arrhythmias in children with syncope or palpitations. This study shows a high diagnostic yield in a paediatric cardiology setting, aiding in patient management.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Medical Devices
Background:
- Implantable loop recorders (ILRs) are effective for managing syncope, presyncope, and palpitations in adults.
- Limited data exists on ILR utility and patient selection in pediatric populations.
Purpose of the Study:
- To evaluate the diagnostic yield and safety of implantable loop recorders (ILRs) in a pediatric cardiology setting.
- To assess the efficacy of ILRs in identifying arrhythmias in children presenting with recurrent syncope, presyncope, or palpitations.
Main Methods:
- Retrospective evaluation of 23 pediatric patients who underwent ILR implantation over 66 months.
- Analysis of indications for implantation, patient demographics, procedural complications, and diagnostic findings.
- Assessment of symptom recurrence and recorded arrhythmias post-implantation.
Main Results:
- The mean age at ILR insertion was 11.39 years. Indications included syncope (n=11), palpitations (n=9), and presyncope (n=3).
- 15 patients (65.2%) reported recurrent symptoms post-implantation, with 8 (53.3%) having documented arrhythmias (tachycardias and bradycardias).
- The ILR achieved a high diagnostic yield (65.2%), enabling arrhythmic or non-arrhythmic diagnoses in this selected pediatric cohort.
Conclusions:
- Implantable loop recorders (ILRs) are a valuable tool for diagnosing cardiac arrhythmias in children with recurrent unexplained symptoms.
- ILR implantation in pediatric patients demonstrates a high diagnostic yield and acceptable safety profile.
- Further research into optimal patient selection criteria for ILR use in pediatrics is warranted.
Abstract:
The implantable loop recorder (ILR) has proved highly efficacious in the management of syncope, presyncope and palpitations in selected populations. Limited information regarding patient selection and diagnostic yield exists in the paediatric setting. A retrospective evaluation of patients who underwent ILR implantation over a 66-month period, in a tertiary paediatric cardiology unit was conducted. Twenty-three patients (10 male, 13 female) following initial assessment and investigation, were referred for device implantation. The mean age at time of ILR insertion was 11.39 +/- 4.34 (range, 2.0-16.8) years. The indications for ILR were recurrent syncope (n = 11), presyncope (n = 3) or palpitations (n = 9). Four (17.4%) patients had structural heart disease, three (13%) had a positive family history of sudden cardiac death and one (4%) had perinatal arrhythmia. One patient required ILR repositioning, and pocket infection necessitated explantation in one further patient. Minimum follow-up was 7.8 months during which symptoms were reported in 15 (65.2%) patients post-ILR insertion. Eight (34.7%) remained asymptomatic. Of the 15 who experienced symptom recurrence, eight (53.3%) had an arrhythmia recorded. Tachycardias recorded were polymorphic ventricular tachycardia (n = 1) and supraventricular tachycardia (n = 5). Clinically significant bradycardias documented, included sinus arrest (n = 1) and Mobitz type II second degree atrioventricular block (n = 1). The ILR had a high diagnostic yield, enabling an arrhythmic or non-arrhythmic diagnosis in 65.2% of patients with recurrent syncope, presyncope or palpitations in a selected paediatric population.
