Remote Monitoring of Implantable Loop Recorders in Syncope Patients: Management of High Volume of Transmissions

Implantable loop recorder (ILR) is among the first line diagnostic tools in patients with unexplained syncope. When ILRs are followed with remote monitoring (RM) diagnosis can be established readily. However, the challenge in RM is the substantial workload related to false positive findings. The aim of this study was to evaluate the impact of symptom base scheduled monitoring (SBSM) on the efficacy and safety on follow-up of patients with unexplained syncope and large number of nonactionable RM transmissions.

The data of all patients (n = 176) with ILR implantation due to unexplained syncope from first of January 2021 to 31st of December 2024 were collected. Symptom based scheduled monitoring (SBSM), where the alert transmissions were replaced by scheduled quarterly and symptom-triggered transmissions, was introduced after 3 months alert-based follow-up in patients with a high burden of nonactionable transmissions.

Mean age of the patients was 60 ± 17 years (56% female). ILR monitoring led to diagnosis in 34 % of the patients. Median time to diagnosis was 84 days (18-216 days) and the therapy included a pacemaker or an ICD implantation in 85% of them. SBSM was used in 18% of the patients. It was associated neither with an increased need for emergency room visits (p = 0.6) nor with hospitalization (p = 0.8). With SBMS the number of monthly RM transmissions decreased almost 80% from 1.5 to 0.3 transmission/device (p = 0.001).

Our data indicates that the burden related to the non-actionable ILR alerts can be significantly reduced with SBMS without compromising patient safety.

Implantable loop recorders (ILRs) enable prompt diagnosis in patients with unexplained syncope. Unfortunately, they also generate a deluge of false-positive alerts. However, turning off alerts in patients with the highest burden of nonactionable transmissions can reduce the remote-monitoring workload without compromising patient safety.