Idiopathic ventricular arrhythmias detected by an implantable loop recorder in a child with exercise-induced syncope

Syncope is common in the general population. Despite extensive evaluation, including tilt-table testing and electrophysiologic studies, approximately 30% of cases of recurrent syncope remain unexplained. An implantable loop recorder can be used for diagnosis when recurrent syncope has an idiopathic cause. We present the case of a 9-year-old boy who had a history of recurrent, exercise-induced syncope. Results of physical examination and noninvasive diagnostic testing were inconclusive, and an electrophysiologic study revealed no inducible supraventricular or ventricular arrhythmias. Sixteen months after an implantable loop recorder was placed, the patient had a syncopal episode while swimming in a pool. Cardiopulmonary resuscitation was performed, and data from the loop recorder revealed polymorphic ventricular tachycardia and ventricular fibrillation. A cardioverter-defibrillator was subsequently implanted. Implantable loop recorders can play an important role in the diagnosis of life-threatening arrhythmias in children whose syncope is otherwise unexplained.