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Implantable loop records in paediatric pratice
Insights
The implantable loop recorder (ILR) successfully diagnosed the cause of persistent syncope and palpitations in all pediatric patients studied. This technology aids in establishing appropriate therapy for children with unexplained cardiac symptoms.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Diagnostic Technology
Background:
- Syncope and palpitations are common in children, posing diagnostic challenges when standard tests are inconclusive.
- The role of the implantable loop recorder (ILR) in pediatric practice requires further definition.
- Adult studies demonstrate ILR's efficacy in diagnosing recurrent syncope.
Purpose of the Study:
- To evaluate the diagnostic yield of the implantable loop recorder (ILR) in children and young adults.
- To determine the effectiveness of ILR in identifying the cause of unexplained cardiac symptoms in pediatric patients.
Main Methods:
- A study involving seven pediatric patients (mean age 12.8 years) who underwent ILR implantation.
- Patients presented with symptoms including syncope, palpitations, and acute life-threatening events (ALTE).
- Previous diagnostic testing included ECG, echocardiogram, Holter monitoring, and electrophysiological studies.
Main Results:
- Four out of seven patients (57%) experienced persistent symptoms despite prior investigations.
- The implantable loop recorder (ILR) was implanted in patients with recurrent syncope, palpitations, or ALTE.
- Follow-up averaged 7.5 months, with symptoms persisting in 57% of the cohort.
Conclusions:
- The implantable loop recorder (ILR) was diagnostic in all pediatric patients with persistent symptoms.
- ILR implantation facilitated the establishment of correct diagnoses and guided appropriate therapeutic interventions.
- This study supports the utility of ILR in the pediatric population for diagnosing challenging cardiac events.
Background:
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.
Aim:
The aim of this article is to assess the diagnostic yield of the ILR in children and young adults.
Methods:
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.
Results:
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.
Conclusions:
The ILR enabled the correct diagnosis to be established in all four patients with persistent symptoms allowing appropriate therapy to be given.
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