Implantable loop records in paediatric pratice

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 paediatric practice its role still has to be defined.

The aim of this article is to assess the diagnostic yield of the ILR in children and young adults.

Seven patients, four male and three female, were included in the study. The mean age at implantation was 12.8 years, with a range from 0.8 to 25.9 years.

The symptoms leading to ILR implantation were recurrent syncope or near-syncope (n=3), syncope in combination with palpitations (n=2), and syncope with an acute life-threatening event (ALTE) (n=2). Previous testing included 12-lead ECG (n=7), echo (n=7), 24-hour Holter (n=7), four-week ambulatory Holter (n=3), exercise test (n=4) and invasive electrophysiological study (n=3). Over a mean follow-up period of 7.5 months (range 3 to 16 months), four (57%) patients continued to have symptoms.

The ILR enabled the correct diagnosis to be established in all four patients with persistent symptoms allowing appropriate therapy to be given.