Implantable loop recorders in patients with heart disease: comparison between patients with and without syncope
Amira Assaf1, Rafi Sakhi1, Michelle Michels1
1Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Implantable loop recorders (ILRs) provide similar diagnostic value for heart disease patients with syncope or non-syncopal symptoms. This finding supports ILR use across various symptomatic presentations in cardiac patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Patients with heart disease face elevated risks of sudden cardiac death.
- Implantable loop recorders (ILRs) are recommended for sporadic, potentially arrhythmia-related symptoms.
- Clinical ILR use predominantly focuses on unexplained syncope.
Purpose of the Study:
- To compare the clinical utility of ILRs in heart disease patients with syncope versus those with non-syncopal symptoms.
- To evaluate actionable events and device implantation rates between symptomatic groups.
Main Methods:
- Observational, single-center study including 120 symptomatic heart disease patients receiving an ILR.
- Primary endpoint: actionable arrhythmic events leading to management changes.
- Secondary endpoint: events necessitating device implantation.
Main Results:
- No significant difference in 3-year actionable event rates between syncope (38%) and non-syncope (39%) groups (p=0.54).
- Similar 3-year device implantation rates between groups (21% vs 13%, p=0.65).
- Underlying conditions included inherited cardiomyopathy, congenital heart disease, and channelopathy.
Conclusions:
- ILR yield is comparable for symptomatic heart disease patients, irrespective of syncope history.
- Findings suggest ILRs are valuable for both syncopal and non-syncopal symptomatic cardiac patients.
Objective:
Patients with heart disease are at increased risk for sudden cardiac death. Guidelines recommend an implantable loop recorder (ILR) for symptomatic patients when symptoms are sporadic and possibly arrhythmia-related. In clinical practice, an ILR is mainly used in patients with unexplained syncope. We aimed to compare the clinical value of an ILR in patients with heart disease and a history of syncope versus those with non-syncopal symptoms.
Methods:
In this observational single-centre study, we included symptomatic patients with heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to device implantation.
Results:
One hundred and twenty patients (mean age 47±17 years, 49% men) were included. The underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%) and other (18%). Group A consisted of 43 patients with prior syncope and group B consisted of 77 patients with palpitations and/or near-syncope. The median follow-up duration was 19 months (IQR 8-36). The 3-year cumulative event rate was similar between groups with regard to the primary endpoint (38% vs 39% for group A and B, respectively, logrank p=0.54). There was also no difference in the 3-year cumulative rate of device implantation (21% vs 13% for group A and B, respectively, logrank p=0.65).
Conclusion:
In symptomatic patients with heart disease, there is no difference in the yield of an ILR in patients presenting with or without syncope.
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