Abstract 20882: Implantable Loop Recorder in Inherited Arrhythmogenic Diseases: A Critical Tool for Symptom Diagnosis and Advanced Risk Stratification
Introduction: A significant challenge in the management of patients (pts) with inherited arrhythmias (IADs) is the retrospective assessment of events suspected to be clinically relevant. Long term monitoring is critical for the adjudication of syncope and/or palpitations to guide the appropriate use of the ICD for primary prevention.
Hypothesis: Implantable loop recorders (ILR) are safe and essential for adjudication of high-risk events in pts with IADs.
Methods: We retrospectively reviewed data of all pts referred to the NYU Cardiovascular Genetics Program who underwent insertion of an ILR between 2009-2016.
Results: Thirty subjects underwent insertion of an ILR and were followed for a median time of 17 months (IQR 7, 37). There were no complications related to the procedure. In the study group, 53% pts had an established diagnosis (mean age 35 ± 4 years): 5 Brugada 5 Long QT syndromes, 2 CPVT, 2 Hypertrophic and 1 Arrhythmogenic cardiomyopathies. The median time to recurrence was 4 months (IQR 1.2, 23) in 6/16 (38%) symptomatic patients. Recurrent syncope was experienced in 1 LQT1 in which the ILR recording correlated with a vasovagal episode. Supraventricular tachyarrhythmias (SVT) or bradyarrhythmias were observed in 6 symptomatic pts. No sustained ventricular arrhythmias were documented. Forty-seven percent of patients referred with suspect IADs without meeting clear diagnostic criteria underwent ILR implant based on a history of significant prior clinical events. These subjects were younger (mean age 23 ± 3 years; p=0.03) with a median time to recurrence of 6 months (2, 28) in 64% (9/14). Syncope was present prior to implantation in 86% (12/14) and a recurrence was observed in 42% correlating with 3 vasovagal episodes and 2 episodes of sustained SVT. Arrhythmias without syncope occurred in 43% (2 PVCs, 1 inappropriate sinus tachycardia, 2 SVT). Importantly, no sustained ventricular arrhythmias were recorded.
Conclusions: Our experience utilizing ILR monitoring in a tertiary center with expertise in cardiovascular genetics confirms its safety and establishes an important role in symptom diagnosis, allowing more advanced rhythm correlation and preventing potentially unnecessary ICD implantation.
Author Disclosures: A. Dwivedi: None. J. Joza: None. M. Cerrone: None. S. Fowler: None. L. Chinitz: None.
- © 2016 by American Heart Association, Inc.