scholarly journals Incidence, diagnostic yield and safety of the implantable loop-recorder to detect the mechanism of syncope in patients with and without structural heart disease

2004 ◽  
Vol 25 (13) ◽  
pp. 1116-1119 ◽  
Author(s):  
A SOLANO
Keyword(s):  
Heart Disease ◽  
Diagnostic Yield ◽  
Structural Heart Disease ◽  
Implantable Loop Recorder ◽  
Loop Recorder

Role of implantable loop recorder in the clinical diagnosis of syncope: Results of the introduction of an effective diagnostic tool

2015 ◽  
Vol 156 (15) ◽  
pp. 609-613
Author(s):  
Miklós Somlói ◽  
Emil Toldy-Schedel ◽  
Zoltán Nényei ◽  
Róbert Böszörményi ◽  
János Tomcsányi
Keyword(s):  
Clinical Practice ◽  
Diagnostic Yield ◽  
Diagnostic Algorithm ◽  
Definitive Treatment ◽  
Implantable Loop Recorder ◽  
Everyday Clinical Practice ◽  
Loop Recorder ◽  
Early Application ◽  
Electrocardiographic Monitoring ◽  
The Everyday

Introduction: Extension of electrocardiographic monitoring via loop recorder implantation may increase the diagnostic yield of syncope work-up. Aim: In this retrospective observational study, the authors wanted to evaluate the diagnostic performance of implantable loop recorder in the everyday clinical practice. Method: The authors analyzed the electronically stored data of all patients who underwent loop recorder implantation between 2005 and 2014 in their cardiology department because of recurrent syncope of undetermined origin. Results: There were 52 loop recorder implantations within the study period. During the 167 (±136) days of monitoring, 36 (69.2%) diagnostic events occurred. In two-thirds of events, (46.2% of all monitored patients) a specific arrhythmia diagnosis was reached, allowing definitive treatment in these cases. In this selected population, there was no correlation between age, presence of known high-risk predictors, or accompanying trauma, and the mechanism of syncope. Conclusions: The high diagnostic rate of implantable loop recorder in the everyday clinical practice is in accordance with the findings in prospective clinical studies. This observation supports the early application of loop recorder in the diagnostic algorithm of syncope. Orv. Hetil., 2015, 156(15), 609–613.

Abstract 2928: Sudden Arrhythmic Death Syndrome-Diagnostic Yield Of Combined Clinical & Genetic Screening In A British Specialist Clinic

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Pier D Lambiase ◽  
Juan C Kaski ◽  
Eileen Firman ◽  
Perry M Elliott ◽  
Akbar K Ahmed ◽  
...  
Keyword(s):  
Heart Disease ◽  
Genetic Testing ◽  
Screening Programme ◽  
Diagnostic Yield ◽  
Challenge Test ◽  
Structural Heart Disease ◽  
Clinical Screening ◽  
Arrhythmic Death ◽  
Sudden Arrhythmic Death Syndrome ◽  
Index Cases

Introduction: Sudden arrhythmic death syndrome (SADS) arises through disorders of ion channel function or structural heart disease. It accounts for over 400 deaths in the UK per annum. To date there has been no comprehensive analysis of the diagnostic yield and efficacy of a family screening approach in SADS index cases where the post mortem heart is structurally normal after expert pathological review. Methods: 118 SADS families where the SADS victim died between 1 and 35 years of age were evaluated in a systematic family screening programme between 2003–2006. All SADS index cases had a structurally normal heart after expert review of all available tissue. All studied relatives underwent resting, signal averaged ECG, 24h Holter, exercise ECG with V0 2 max, transthoracic echocardiography and an ajmaline challenge test after initial clinical screening. Systematic mutation analysis was performed on the known long QT (LQT)genes including SCN5A & ryanodine receptor/ARVC genes when clinically suspected. Results: The most common modes of death were rest in 28%, sleep in 25% and exercise in 18%. Clinical screening identified an inherited electrical cause of SADS in 41 of the 118 families (35%)-20 Brugada, 18 LQT Syndrome, 3 Catecholiminergic Polymorphic Ventricular Tachycardia (CPVT). Structural heart disease was identified in 5 ARVC & 2 DCM families. 26 ICDs have been implanted in affected family members-4 LQTS, 7 Brugada, 2 CPVT, 2 ARVC, 2 DCM and 9 on clinical grounds without a definitive diagnosis. The ECG (37%) and ajmaline challenge test (49%) had the highest diagnostic yield in families with a positive diagnosis. To date, genetic testing has increased the diagnostic yield by 5% (6/118 families-2 KCNQ1, 1 HERG, 2 SCN5A, 1 ARVC ), confirming a clinical diagnosis in 6.6%–3 KCNQ1, 3 SCN5A, 1 HERG, 1 KCNH2. Conclusions: Systematic clinical screening in relatives of SADS victims has a diagnostic yield of 35% increasing to 40% with genetic testing. Electrical causes of SADS predominate in these families. These findings demonstrate that a systematic clinical screening programme in SADS families is both achievable and effective. The full impact of gene testing (including RyR mutations) upon diagnostic yield is awaited.

scholarly journals Inappropriate Asystole Detection in Early Postoperative Phase after Loop Recorder Implantation

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Miriam Bortnik ◽  
Eraldo Occhetta ◽  
Andrea Magnani ◽  
Anna Degiovanni ◽  
Paolo Marino
Keyword(s):  
Diagnostic Tool ◽  
Diagnostic Yield ◽  
Subcutaneous Tissue ◽  
Postoperative Phase ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Unexplained Syncope

The implantable loop recorder is a useful diagnostic tool for patients with unexplained syncope. The capability to automatically detect and store arrhythmic events, implemented in the last generations of these devices, can further improve the diagnostic yield, but this feature can be compromised by inappropriate detection of false arrhythmias. We herein report the case of a patient in which several inappropriate activations of long-lasting asystole occurred in the two days following the implant, probably because of an intermittently loose contact between the device and subcutaneous tissue for a small pocket haematoma.

scholarly journals Implantable loop recorder for monitoring patients with congenital heart disease

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Michael Huntgeburth ◽  
Christopher Hohmann ◽  
Peter Ewert ◽  
Sebastian Freilinger ◽  
Nicole Nagdyman ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Implantable Loop Recorder ◽  
Loop Recorder

Use of an implantable loop recorder in the evaluation of children with congenital heart disease

2002 ◽  
Vol 143 (2) ◽  
pp. 366-372 ◽  
Author(s):  
Shubhayan Sanatani ◽  
Alejandro Peirone ◽  
Christine Chiu ◽  
Derek G. Human ◽  
Gil J. Gross ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Implantable Loop Recorder ◽  
Loop Recorder

Performance of an implantable loop recorder in the detection of heart rhythm disturbances in patients with syncope and embolic strokes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kremer ◽  
D.S Stierle ◽  
H Naegele
Keyword(s):  
Atrial Fibrillation ◽  
False Positive ◽  
Diagnostic Yield ◽  
Detection Performance ◽  
True Positive ◽  
Implantable Loop Recorder ◽  
Time To Event ◽  
Loop Recorder ◽  
Time To Diagnosis ◽  
Mean Time

Abstract Aims The primary goal of this study was the evaluation of the arrhythmia detection performance of an implantable loop recorder (ILR) in patients with syncope of unknown etiology and patients with embolic stroke of undetermined source (ESUS). Secondary goals were the evaluation of diagnostic yield, time to diagnosis and established therapeutical consequences. Methods The Reveal LINQ ILR was implanted in n=143 patients (n=84 after ESUS, n=59 after syncope). Automatically detected episodes (n=3213) were transmitted via internet and validated by two experienced cardiologists and either classified as correct or incorrect. Positive-predictive value (ppv = true-positive episodes/true-positive episodes + false-positive episodes) was calculated for each available arrhythmia type. Incorrect episodes were classified as undersensing, oversensing, artifacts or supraventricular/ventricular ectopic beats. The diagnostic yield was defined by asystole ≥3 seconds or the detection of atrial fibrillation. Time to diagnosis was calculated as the time from implantation to detection of an asystole or atrial fibrillation. Results Every second asystole episode in syncope-patients was false-positive (ppv 52%), mostly due to undersensing. The atrial fibrillation detection performance in ESUS-patients was 70% (ppv-average). The majority of false-positive episodes was due to premature atrial and ventricular complexes (80%), followed by artifacts (14%) and oversensing (4%). Undersensing accounted for 2%. 36% of syncope-patients were diagnosed with an asystole after a mean time to event of 114 days. In 47% of syncope-patients diagnosed with asystole, a pacemaker was implanted. In 31% of ESUS-patients a diagnosis of atrial fibrillation was established, after a mean time to event of 92 days. 85% of ESUS-patients diagnosed with atrial fibrillation were ultimately treated with an oral anticoagulant. Conclusion and discussion The Reveal Linq ILR - advertised as an automatic diagnostic tool for syncope- and ESUS-patients - has its caveats. A high number of false-positive detections due to undersensing limited the asystole detection performance. The atrial fibrillation detection performance presented more reliable, despite a substantial number of false-positive detections. A time-consuming manual episode review still represents an indispensable step in the diagnostic process, and enough human resources have to be factored before starting an ILR program. Funding Acknowledgement Type of funding source: None

scholarly journals First Vs Recurrent Syncope In Patients With Structural Heart Disease Or Bundle Branch Block

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Francisco Pascual ◽  
N Rivas Gandara ◽  
A Santos Ortega ◽  
J Perez Rodon ◽  
B Benito ◽  
...  
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Diagnostic Yield ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
First Episode ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Syncope Episode ◽  
Work Up

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Vall d"Hebron - Vall d"Hebron Institut de Recerca. CIBERCV BACKGROUND Patients with structural heart disease (SHD) or bundle branch block (BBB) are at high risk of having an arrhythmic syncope (AS).  In patients with recurrent syncope episodes (RSE)  complete work-up including electrophysiological study (EPS) and/or implantation of a loop recorder (ILR) is recommended, however patients with their first episode may also be at risk of an AS. AIM To determinate if the patients with SHD or BBB with a single syncope episode (SSE) are at high risk of having an AS and compare it with patients with recurrent episodes (RSE). METHODS Cohort study carried out in a tertiary hospital that is a reference centre for syncope. From January 2008 to August 2020 patients with SHD or BBB with syncope of unknown origin after the initial evaluation and without direct indication of an ICD were included. They were managed according the current ESC guidelines. RESULTS 417patients were included  (74 ±11 y. o; 39% female). Mean follow up was 2.5 ±1 y. 223 patients were diagnosed from an AS [113 (53%) in SSE group and 110 (54%) in RSE group, p = 0.9], 210 were due to bradyarrhythmia (AV block or sinus arrest). No differences in baseline characteristics where found comparing both groups, except that BBB was slightly more prevalent in patients with RSE (81% vs 90%, p = 0.01) (FIGURE- PANEL A). Risk of AS was 53% in patients with SE and 54% (p = 0.9). RSE were not associated with an increased risk of AS in univariate analyses (OR 1.01 IC95% 0.7-1.5) neither in the multivariate (FIGURE- PANEL B). EPS and ILR diagnostic yield was 45% / 32% respectively in SSE group and 44% / 33% in RSE group (p = 0.8) (FIGURE - PANEL C).  After appropriate treatment, recurrence syncope rate was 10% in SSE group and 9% in RSE group (p = 0.8). No significant differences in mortality rate were found. CONCLUSIONS Patients with SHD or BBB and single syncope episode are at a high risk of having AS, and similar to those with RSE. EPS and ILR offer a similar diagnostic yield in both groups. Complete syncope work-up must be recommended in these patients despite having had only a single episode. Abstract Figure

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