scholarly journals Do implantable loop recorders impact the survival of patients with recurrent unexplained syncope?

2021 ◽  
Author(s):  
Christian Perings ◽  
Claudia Wolff ◽  
Adrian Wilk ◽  
Andreas Witthohn ◽  
Rainer Voss ◽  
...  
Keyword(s):  
Claims Data ◽  
Positive Impact ◽  
Control Group ◽  
Implantable Loop Recorder ◽  
Diagnostic Device ◽  
Loop Recorder ◽  
Impact On Survival ◽  
Unexplained Syncope ◽  
Comorbidity Index ◽  
Implantable Loop Recorders

Aim: This study compares the outcomes of patients who receive an implantable loop recorder (ILR) for unexplained syncope to a control group without the diagnostic device in German claims data. Methods  and materials: Patients with ILR were matched to a control group based on prior syncope events, age, gender and Charlson Comorbidity index (CCI). Survival, syncope hospitalizations, treatment and costs were compared. Results/conclusion: Four hundred and twelve ILR patients were matched with controls, mean age was 68, mean CCI was 2.7, 42% females. ILR patients lived on average 1.2 years longer than patients in the control group. Twenty-five percent of ILR patients received a therapeutic device compared with 5% in the control group. ILRs might help to diagnose and treat patients with positive impact on survival.

scholarly journals Patients with recurrent syncope and implantable loop recorder exhibit better survival than the control group without implantable loop recorder

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Perings ◽  
C Wolff ◽  
A Wilk ◽  
A Witthohn ◽  
R Voss ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Control Group ◽  
Funding Source ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Cardiac Device ◽  
Unexplained Syncope ◽  
Care Costs

Abstract Introduction In 30% of patients with syncope, the underlying cause remains unexplained after clinical investigations. Unexplained syncope tends to recur, significantly impacting patients' quality of life of patients and mortality. Thus, there is a need for timely and more accurate diagnosis to initiate treatment. Dedicated care pathways are recommended by ESC guidelines. Purpose Patients with recurrent syncope were followed over time and patient outcomes with ILR were compared to patients with the same syncope burden, age, gender and mortality risk score who did not receive an ILR. Method A representative database of 4.9 million patients insured by German company statuary health insurances (BKK) was analysed over a time period of 10 years, 2007–17. Patients with recurrent syncope (two times ICD-10 GM diagnosis codes R55), age between 45–84 and no diagnosis code for the syncope were included in the analysis and followed for at least 2 years. Patients with ILR were matched to patients without ILR based on age, gender and Charlson Comorbidity index (CCI) using mahalanobis distances. The index event was the device implant in the ILR group and the second syncope event in the control group. Life expectancy, syncope hospitalisations, fall related injuries, health care costs, diagnoses and treatment rates were compared between the groups. Results A total of 412 patients with ILR for recurrent unexplained syncope were matched to the control group. Overall mean age was 68, mean was CCI 2.7, 42% were females. The risk of death was 2.35 times higher in the control group during follow up as shown in Figure 1 (p-value logrank test <0.0001). Cardiovascular related diagnosis and treatment rates were higher in the ILR group with 69% of patients having a cardiology diagnosis compared to 41% in the control group. Over a quarter (27%) of ILR patients received an implantable cardiac device compared to 5% in the control group. Ablation rates were 7% in the ILR group compared to 0% in the control group. Median health care costs were € 3,847 higher in the ILR group including the costs of the ILR implant, follow up and higher rates of cardiac treatments. These extra costs appear moderate given the substantially higher mortality risk in the control group. Conclusion This study of patients with recurrent unexplained syncope shows a remarkable difference in life expectancy in patients with ILR compared to a matched control group. Two large claim data analysis have recently shown higher rates of cardiovascular death as well as all-cause mortality in patients with unexplained syncope. A more vigilant cardiac workup might be needed to identify a possible underlying cardiac condition. Higher rates of cardiac device therapy in the ILR group were likely to play an important role for their better life expectancy. Cardiac therapies such as pacemakers, defibrillators and ablation have also been shown to significantly improve patients' quality of life. Life Expectancy Comparison Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The data analysis was funded by Medtronic

scholarly journals Implantable Loop Recorder – A Good Opportunity to Diagnose Unexplained Syncope

2016 ◽  
Vol 33 (1) ◽  
pp. 63-68
Author(s):  
Predrag Cvetković ◽  
Zoran Perisić ◽  
Tomislav Kostić ◽  
Aleksandar Stojković ◽  
Miroslav Krstić ◽  
...  
Keyword(s):  
Heart Rhythm ◽  
Implantable Loop Recorder ◽  
Diagnostic Device ◽  
Loop Recorder ◽  
Good Opportunity ◽  
Standard Methods ◽  
Cardiac Syncope ◽  
Unexplained Syncope ◽  
Automatic Activation

Summary Implantable loop recorder (ILR) is a method in cardiology, which is used for the diagnosis of unexplained syncope in patients who were not treated successfully using standard methods. Implantable loop recorder is a diagnostic device that is surgically implanted under the skin of the chest area. This device does not have the endovenous implantation of electrodes; instead, electrodes are attached to the machine housing. The device records the heart rhythm continuously, up to 14 months, and stores data outside the activator whenever symptoms appear, or by the automatic activation of the predefined program for bradycardia, asystole, and tachycardia. The aim of this paper was to describe the method for the detection of cardiac syncope with the use of implantable loop recorder.

scholarly journals Implantable loop recorder: experience of a center

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Marques Pires ◽  
P Medeiros ◽  
C Oliveira ◽  
I Campos ◽  
M Flores ◽  
...  
Keyword(s):  
Positive Impact ◽  
Blood Pressure Monitoring ◽  
Electrophysiological Study ◽  
Stress Test ◽  
Sinus Node ◽  
Oral Anticoagulants ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Implantable Loop Recorder ◽  
Diagnostic Challenge ◽  
Loop Recorder

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Symptoms like syncope and palpitations are frequent and represent a diagnostic challenge. The implantable loop recorder (LR) is an important diagnostic tool, in selected cases. AIM To describe the main implantation indications of LR and to evaluate the diagnostic findings and therapeutic interventions. METHODS A retrospective study of patients (pts) that underwent LR implantation in our hospital from 2014 to 2019. For each pt the indication for implantation, baseline characteristics, previous study, recorded tracing and interventions were evaluated. RESULTS A total of 52 pts were included, 56% women, with a mean age of 60 years old. The implantation indications were recurrent syncope/ presyncope in 47 pts (90%) and palpitations in 5 pts (10%). All pts had a baseline echocardiogram and electrocardiogram, with 90% in sinus rhythm. QRS complex and atrial-ventricular conduction was normal in 50% of the pts. Previous to LR implantation, 46 pts (89%) had performed Holter, 19 (37%) carotid sinus massage, 14 (27%) Tilt table test, 29 (56%) stress test, 11(21%) ambulatory blood pressure monitoring and 9 (17%) electrophysiological study. During the monitoring period, 27 pts (52%) had recurrence of the symptoms. In this subgroup, we observed that 67% had a rhythmic cause capable of justified the symptoms, with a median of 5 months since implantation until diagnosis. In addition, the LR was useful in ruling out a rhythmic cause for symptoms in 33% of the cases. In the 47 pts with syncope/presyncope: 6(13%) had sinus node dysfunction, 4 (9%) had atrioventricular conduction disturbance, 1(2%) had atrial fibrillation (AF) and 3 (6%) had ventricular dysrhythmias. In the 5 pts with palpitations: 1(20%) had AF ad 3 (60%) had paroxysmal supraventricular tachycardia. LR results led to cardiac device implantation in 13 pts (pacemaker-9, implantable cardioverter desfibrillator-4). In addition, 2 pts are waiting for electrophysiological study and eventual ablation and 3 pts initiated antiarrhythmic therapy, and those with new diagnosis of AF also initiated oral anticoagulants. CONCLUSION In this study, the implantation of LR was useful to clarify the cause of the symptomology in 52% of the pts. In 35% of pts with symptom-rhythm correlation it ensured timely introduction of therapeutic approach with a positive impact on life quality.

scholarly journals Implantable loop recorder follow-up

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Pena Mellado ◽  
R Macias ◽  
L Tercedor ◽  
M Alvarez Lopez
Keyword(s):  
Head Trauma ◽  
Type I ◽  
Av Block ◽  
Implantable Loop Recorder ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Tertiary Center ◽  
Unexplained Syncope ◽  
Baseline Characteristics

Abstract Introduction Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients. Purpose To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center. Methods A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated. Results One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (>50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by >3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related. Conclusion In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics Arrhythmias detected during follow-up

scholarly journals Discrepancy between clinical practice and standardized indications for an implantable loop recorder in patients with unexplained syncope

EP Europace ◽  
2010 ◽  
Vol 12 (10) ◽  
pp. 1475-1479 ◽  
Author(s):  
E. Vitale ◽  
A. Ungar ◽  
R. Maggi ◽  
M. Francese ◽  
M. Lunati ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Unexplained Syncope

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.

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