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J Cardiovasc Electrophysiol. 2012 Jan;23(1):67-71. doi: 10.1111/j.1540-8167.2011.02133.x. Epub 2011 Jul 21.

Additional diagnostic value of very prolonged observation by implantable loop recorder in patients with unexplained syncope.

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1
Arrhythmologic Center, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy.

Abstract

INTRODUCTION:

In the literature, the average diagnostic yield of the implantable loop recorder (ILR) is reported to be 35% over an observation period generally less than 18 months. The aim of this study was to evaluate the diagnostic value of ILR during very prolonged observation.

METHODS AND RESULTS:

Consecutive patients who had received one or more (in the case of battery exhaustion before diagnosis) ILR (Reveal/plus/DX, Medtronic Inc.) from 2001 to 2010 were included. The diagnostic ECG was classified according to the ISSUE classification. We analyzed 157 patients (87 males, 69 ± 14 years): 70 of these were followed up for ≥18 months. The estimated cumulative diagnostic rates were 30%, 43%, 52%, and 80% at 1, 2, 3, and 4 years, respectively; 26% of diagnoses were made after 18 months. The diagnostic yield was independent of structural heart disease, bundle branch block, number of syncopes, age, and gender; the median time to diagnosis of ISSUE type 1 patients was shorter than that of the others (4 [2;10] vs. 16 [6;23] months; P = 0.003). During the observation period, 3 patients (1.9%) died and none suffered arrhythmic death.

CONCLUSIONS:

Prolonging observation up to 4 years increased the diagnostic value of ILR in syncopal patients and was safe. A quarter of patients diagnosed needed more than 18 months of follow-up. As consequence, when a strategy of prolonging monitoring is chosen, monitoring should be maintained even for several years until diagnosis is established.

[Indexed for MEDLINE]

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