Abstract 18639: Clinical Impact of Implantable Loop Recorders on Management of Patients with Recurrent Syncope and Cryptogenic Cerebrovascular Accident
Introduction: Implantable loop recorder (ILR) - a small leadless subcutaneous device with two electrodes - can be used for long-term electrocardiographic (ECG) monitoring. The device can be triggered manually or follow preset arrhythmia algorithms. Current guidelines recommend utilization of ILR in ambulatory settings for patients with recurrent syncope or cryptogenic stroke. We present our initial experience with such a device (Medtronic Reveal XT 9529).
Methods: Over a 36-month period, 34 adults (mean age 61±18 years, 53% men) with recurrent unexplained syncope [n=28 (82%)] or cryptogenic stroke [n=6 (18%)], following an inconclusive clinical work-up, underwent ILR implantation. Clinical and demographic data as well as all patient and-auto-triggered ECG data were reviewed over an average follow up period of 32 (range 14-55) months.
Results: Workup prior to implantation included 12-lead ECG and telemetry data (100%), transthoracic echocardiogram (97%), transesophageal echocardiogram (2.9%), electroencephalogram (10%), 24-hour ambulatory ECG monitor (23.5%), tilt table test (14.7%), computed tomographic imaging of the head (11.7%), pharmacologic (regadenosan) myocardial perfusion imaging (14.7%), carotid ultrasound (26.9%), invasive electrophysiology study (8.8%), and magnetic resonance imaging of the brain (2.9%). During the follow up period, an etiology for recurrent syncope was identified in 28.6% (8/28) and previously unsuspected paroxysmal atrial fibrillation was found in 33% (2/6) of patients with cryptogenic stroke. The findings resulted in a change in the clinical management of 10 of 34 (29.4%) patients including pacemaker implantation for bradyarrhythmias in 11.7% (4/34), radiofrequency ablation for atrioventricular node reentrant tachycardia in 2.9% (1/34), and initiation of anticoagulation therapy in 11.7% (4/34). No complication was associated with these implantable devices.
Conclusions: ILR is a safe and effective means of determining the etiology of recurrent unexplained syncope and identifying paroxysmal atrial fibrillation as a potential cause of cryptogenic stroke.
Author Disclosures: A. Abichandani: None. H. Vefali: None. D. Signarovitz: None. L. Chebrolu: None. J. Shirani: None. D. Traub: None.
- © 2014 by American Heart Association, Inc.