The use of a selection of directly programmed fixed duration biphasic shocks had a striking impact on the HEDFT for these difficult patients. Adequate safety margins were obtained for 12 of 16 patients with no lead manipulation or other approaches.

The implantable loop recorder (ILR) has proved highly efficacious in the management of syncope, presyncope and palpitations in selected populations. Limited information regarding patient selection and diagnostic yield exists in the paediatric setting. A retrospective evaluation of patients who underwent ILR implantation over a 66-month period, in a tertiary paediatric cardiology unit was conducted. Twenty-three patients (10 male, 13 female) following initial assessment and investigation, were referred for device implantation. The mean age at time of ILR insertion was 11.39 +/- 4.34 (range, 2.0-16.8) years. The indications for ILR were recurrent syncope (n = 11), presyncope (n = 3) or palpitations (n = 9). Four (17.4%) patients had structural heart disease, three (13%) had a positive family history of sudden cardiac death and one (4%) had perinatal arrhythmia. One patient required ILR repositioning, and pocket infection necessitated explantation in one further patient. Minimum follow-up was 7.8 months during which symptoms were reported in 15 (65.2%) patients post-ILR insertion. Eight (34.7%) remained asymptomatic. Of the 15 who experienced symptom recurrence, eight (53.3%) had an arrhythmia recorded. Tachycardias recorded were polymorphic ventricular tachycardia (n = 1) and supraventricular tachycardia (n = 5). Clinically significant bradycardias documented, included sinus arrest (n = 1) and Mobitz type II second degree atrioventricular block (n = 1). The ILR had a high diagnostic yield, enabling an arrhythmic or non-arrhythmic diagnosis in 65.2% of patients with recurrent syncope, presyncope or palpitations in a selected paediatric population.