JOURNAL ARTICLE

Diagnostic and therapeutic value of implantable loop recorder: A tertiary care center experience

Deepak Padmanabhan, Krishna Kancharla, Majd A El-Harasis, Ameesh Isath, Nayani Makkar, Peter A Noseworthy, Paul A Friedman, Yong-Mei Cha, Suraj Kapa
Pacing and Clinical Electrophysiology: PACE 2019, 42 (1): 38-45
30357866

BACKGROUND: Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. However, diagnostic yield in routine clinical practice is not well established.

METHODS: Patients undergoing ILR implantation between April 2010 and May 2015 were included. All devices were enrolled in remote monitoring with automatic arrhythmia detection and P sense algorithms switched "ON." Symptom-rhythm correlation was assessed and changes in management were recorded.

RESULTS: A total of 312 patients (57% male, age 53 ± 22 years; median CHADS2VaSc score  =  1) were included in this study. ILRs were implanted for evaluation of syncope in 206 (66.0%), presyncope in 23 (7.4%), unexplained palpitations in 51 (16.3%), and cryptogenic stroke in 27 (8.7%) patients. ILR monitoring yielded a diagnosis that changed management strategy in 146 (46.8%) patients over a median of 12 (1-42) months. Out of 163 (52.2%) patients with symptoms during the monitoring period, 100 (61.3%) had an arrhythmia. ILR was useful in ruling out an arrhythmic cause for symptoms in 63 (38.7%) patients. ILR results led to pacemaker implantation in 23 patients (7.4% overall and 11.2% of those with syncope) after median follow-up of 3 months. A new diagnosis of atrial fibrillation was made in 38 (12.2%) patients, 11 of whom were initiated on oral anticoagulants. ILR results led to pacemaker implantation in 31 patients (9.9% overall and 19.0% of those with syncope) after median follow-up of 3 months. A new diagnosis of atrial fibrillation was made in 38 (12.2%) patients, nine of whom were initiated on oral anticoagulants. Overall, ILR led to a change in management in 47% patients with a number needed to implant of 2.1 to change management.

CONCLUSION: ILR monitoring is effective in achieving symptom-rhythm correlation and results in changes in management in nearly half of implanted patients. Additional studies are needed to evaluate cost efficacy of ILR and the optimal monitoring duration.

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