Implantable Loop Recorders – South East Ireland Experience

Background Implantable loop recorders are subcutaneous cardiac devices that offer prolonged monitoring, particularly used in patients with infrequent symptoms, recurrent syncope, or to identify episodes of atrial fibrillation post stroke. Methods The data was collected from TOMCAT, a total of 318 Implantable Loop Recorders were inserted from 2020-2022. The study focused on identifying the clinical indications for insertion and evaluating the outcomes. Results The patient cohort had a mean age of 64.9 years and a median age of 67 years. Regarding the specialties of the requestors, 70% of requests were made by cardiologists, and 15.7% by geriatric medicine consultants. The majority of requests originated from University Hospital Waterford (75%), followed by South Tipperary Hospital (17.3%) and Wexford General Hospital (7.5%). In terms of indications, 46% of Implantable Loop Recorder insertions were performed for syncope workup, 25% for the evaluation of stroke, transient ischemic attacks, or detection of atrial fibrillation, 12% for palpitations, 7% for presyncope, and 1.6% for dizziness. Among the 318 Implantable loop recorders analysed, a positive outcome was observed in 30% of cases. Of these, 51% subsequently required the implantation of a Permanent Pacemaker, Implantable Cardioverter-Defibrillator (ICD), or Cardiac Resynchronization Therapy (CRT) device. Conclusion Implantable loop recorders can be a valuable diagnostic tool particularly in patients with recurrent unexplained syncope despite extensive clinical evaluation. Additionally, they can be utilised to identify atrial fibrillation following a cryptogenic stroke. This study highlighted University Hospital Waterford as the primary centre for cardiac diagnostics in the southeast, accounting for most requests.