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

doi:10.1111/pace.13533

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

Pacing Clin Electrophysiol. 2019 Jan;42(1):38-45. doi: 10.1111/pace.13533. Epub 2018 Dec 4.

Authors

Deepak Padmanabhan¹, Krishna Kancharla¹, Majd A El-Harasis², Ameesh Isath¹, Nayani Makkar¹, Peter A Noseworthy¹, Paul A Friedman¹, Yong-Mei Cha¹, Suraj Kapa¹

Affiliations

¹ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
² Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA.

PMID: 30357866
DOI: 10.1111/pace.13533

Abstract

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.

Keywords: arrhythmia; implantable loop recorder; stroke; syncope.

MeSH terms

Anticoagulants / administration & dosage
Arrhythmias, Cardiac / diagnosis*
Arrhythmias, Cardiac / physiopathology
Arrhythmias, Cardiac / therapy*
Electrocardiography, Ambulatory / instrumentation*
Female
Humans
Male
Middle Aged
Pacemaker, Artificial
Tertiary Care Centers
Treatment Outcome

Substances

Anticoagulants