Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

Huemer, Martin; Becker, Ann‐Kristin; Wutzler, Alexander; Attanasio, Philipp; Parwani, Abdul Shokor; Lacour, Philipp; Boldt, Leif‐Hendrik; Pieske, Burkert; Haverkamp, Wilhelm; Blaschke, Florian

doi:10.5603/cj.a2018.0008

Cited by 16 publications

(17 citation statements)

References 43 publications

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“…Therapeutic interventions were common after ICM placement for unexplained syncope, as more than 28% of the patients in our cohort underwent an intervention within 2 years of ICM follow-up. This is consistent with data from several studies reporting that approximately one in four syncope patients monitored by ICM for 1–3 years receive a pacemaker, implantable cardioverter-defibrillator, or have an ablation performed [ 9 , 12 , 13 ]. The reduction in acute events observed during the follow-up was presumably driven by the administration of therapeutic interventions.…”

Section: Discussionsupporting

confidence: 90%

Syncope Recurrence and Downstream Diagnostic Testing after Insertable Cardiac Monitor Placement for Syncope

et al. 2022

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Despite advances in syncope evaluation strategies and risk stratification, the high cost of syncope is largely driven by extensive and often repetitive testing. This analysis of a large deidentified US claims database compared the use of diagnostic tests, therapeutic procedures, and the recurrence rate of acute syncope events before and after placement of an insertable cardiac monitor (ICM) in syncope patients. The patients had a minimum of 1 year of continuous enrollment before and 2 years after ICM placement. Among 2140 patients identified, a statistically significant reduction in the use of 14 out of 18 tests was observed during follow-up compared with pre-ICM testing. During the 2-year follow-up, 28.3% of patients underwent cardiac therapeutic interventions after a median of 127 days. Significantly fewer patients experienced acute syncope events during the 1st and 2nd years of ICM follow-up compared with the 1-year pre-ICM period, and the frequency of events per patient also decreased. In conclusion, reductions in diagnostic testing and acute syncope events were observed after ICM placement in a large real-world cohort of unexplained syncope patients. Further studies are needed to prospectively assess the impact of ICM vs. short-term monitoring on patient outcomes and healthcare utilization.

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Section: Discussionsupporting

confidence: 90%

Syncope Recurrence and Downstream Diagnostic Testing after Insertable Cardiac Monitor Placement for Syncope

et al. 2022

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“…Comparing to the results of other authors, in our study fewer patients had symptomatic episodes with no arrhythmic abnormalities detected by ILR (Huemer et al, 2019; Kabra et al, 2009). In such cases, the role of ILR is to exclude arrhythmia as primary cause of syncope or palpitations, and the final diagnosis is usually made by a neurologist (in our study, eight patients had unrecognized epilepsy, two psychogenic non‐epileptic seizures, and in six, prolonged neurological monitoring was indicated).…”

Section: Discussionsupporting

confidence: 65%

Diagnostic value of implantable loop recorders in patients with unexplained syncope or palpitations

Radovanović

Pavlović

Kirćanski

et al. 2021

Noninvasive Electrocardiol

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Background The implantable loop recorder (ILR) is a small cardiac rhythm‐monitoring device. Our aim was to determine ILR diagnostic value in patients with unexplained syncope, presyncope, or palpitations suggesting cardiac arrhythmias. Methods This has been a retrospective, observational, single‐center study. We included 181 patients in whom ILR was implanted at the Clinical Center of Serbia between January 2006 and July 2019. An event was marked as diagnostic if it led to a diagnosis and ILR was considered diagnostic if it verified or excluded an arrhythmia as the cause of syncope or palpitations. Results The mean age was 51.8 ± 17.8 years and 94 (51.9%) were male. The mean follow‐up period was 20.2 ± 15.8 months. ILR was diagnostic in 98 patients (54.1%). There was no significant difference in diagnostic value of ILR in regard to the baseline patients’ characteristics. The mean time to occurrence of the diagnostic event was 11.1 ± 9.6 months. The time to occurrence of a diagnostic event did not differ significantly between patients who underwent basic as compared to extended diagnostics before ILR implantation. Conclusions ILR was able to achieve an etiological diagnosis in 54.1% of patients with unexplained syncope, presyncope, or palpitations suggesting cardiac arrhythmias. In a subgroup of patients with recurrent palpitations, ILR was significantly less diagnostic than in patients with syncope or presyncope. ILR should be implanted beforehand in syncope evaluation process.

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“…Thus, the present study cohort consisted mainly of patients without severe structural heart disease. Previous studies have identified the following risk factors for clinically relevant arrhythmia: age, female gender, syncope with injury sequelae, obesity and impaired renal function 8–11 . Older age was also associated with a higher incidence of the primary endpoint in our study (Table 1).…”

Section: Discussionsupporting

confidence: 58%

“…Previous studies demonstrated the usefulness of ILR as a major diagnostic tool, based on the advantage of extended ECG monitoring, in diagnosing unexplained syncope 3–7 . In the past, several clinical characteristics with an association to arrhythmia were identified 7–16 . Nevertheless, data of ILR are still limited and large studies that examined predictors of arrhythmias are rare.…”

Section: Introductionmentioning

confidence: 99%

Predictors for the detection of arrhythmia requiring pacemaker/ICD implantation—Results from a loop recorder study

Kreimer

Aweimer

Backhaus

et al. 2022

Pacing Clinical Electrophis

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Background: There are few large studies on which factors are associated with the occurrence of arrhythmias. Implantable loop recorders (ILR) are useful in detecting arrhythmia due to prolonged and continuous ECG monitoring. Therefore, the aim of this study is to identify and evaluate clinical characteristics and ECG parameters for predicting arrhythmias requiring pacemaker/ICD implantation by analyzing a study cohort with ILR. Methods: This bicentric study comprised a study cohort of 451 patients (mean age 64 ± 16 years, 209 women) receiving ILR implantation between 2011 and 2021. Patients were followed up on a 3 monthly outpatient interval. All arrhythmias with a pacemaker or ICD indication were considered clinically relevant. The primary study endpoint was the detection of clinically relevant arrhythmia. Results: During a follow up of 678 ± 392 days, a clinically relevant arrhythmia was detected in 81 of 451 patients (18%). Multivariate analysis revealed five independent

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Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

Abstract: Background: Implantable loop recorders (ILR) are a valuable tool for the investigation of

Cited by 16 publications

References 43 publications

Syncope Recurrence and Downstream Diagnostic Testing after Insertable Cardiac Monitor Placement for Syncope

Syncope Recurrence and Downstream Diagnostic Testing after Insertable Cardiac Monitor Placement for Syncope

Diagnostic value of implantable loop recorders in patients with unexplained syncope or palpitations

Predictors for the detection of arrhythmia requiring pacemaker/ICD implantation—Results from a loop recorder study

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