Key result
ILRs alter clinical management in ~22% of patients, with changes linked to increasing age.
Why the study?
Implantable loop recorders are routinely used for long-term cardiac monitoring, but their real-world performance regarding management changes made in response to recorded data required examination.
Does implantable loop recorder implantation alter clinical management in patients presenting with syncope, palpitations, cryptogenic stroke, or high arrhythmic risk?
Observational (n=501)
No
Does implantable loop recorder implantation alter clinical management in patients presenting with syncope, palpitations, cryptogenic stroke, or high arrhythmic risk?
Implantable loop recorders frequently lead to actionable management changes in older patients and those with cryptogenic stroke, but rarely alter management in patients under 40 years of age.
May support selective ILR use in older patients; leaves open need for RCTs to confirm outcome benefits.
AIM: Implantable loop recorders (ILRs) are now routinely implanted for long-term cardiac monitoring in the clinical setting. The aim of this study was to examine the real-world performance of these devices focusing on the management changes made in response to ILR-recorded data. METHODS AND RESULTS: This was a single-centre, prospective observational study of consecutive patients undergoing ILR implantation. All patients who underwent implantation of a Medtronic Reveal LINQ device from September 2017 to June 2019 at Barts Heart Centre were included. Five hundred and one patients were included. Three hundred and two (60%) patients underwent ILR implantation for an indication of pre-syncope/syncope, 96 (19%) for palpitations, 72 (14%) for atrial fibrillation (AF) detection with a history of cryptogenic stroke, and 31 (6%) for high risk of serious cardiac arrhythmia. The primary outcome of this study was that an ILR-derived diagnosis altered management in 110 patients (22%). Secondary outcomes concerned subgroup analyses by indication: in patients who presented with syncope/pre-syncope, a change in management resulting from ILR data was positively associated with age [hazard ratio (HR) 1.04, 95% confidence interval 1.02-1.06; P < 0.001] and negatively associated with a normal electrocardiogram at baseline (HR 0.54 [0.31-0.93]; P = 0.03). Few patients (1/57, 2%) aged <40 years in this group underwent device implantation, compared to 19/62 patients (31%) aged 75 years and over (P = 0.0024). Out of 183 (12%) patients, 22 in the 40-74 age range had a device implanted. Among patients who underwent ILR insertion following cryptogenic stroke, 13/72 (18%) had AF detected, leading to a decision to commence anticoagulation. CONCLUSION: These results inform the utility of ILR in the clinical setting. Diagnoses provided by ILR that lead to changes in management are rare in patients under age 40, particularly following syncope, pre-syncope, or palpitations. In older patients, new diagnoses are frequently made and trigger important changes in treatment.
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Sanghvi et al. (2021) conducted an observational in Syncope, palpitations, cryptogenic stroke, or high risk of arrhythmia (n=501). Implantable loop recorder (ILR) was evaluated on ILR-derived diagnosis altering clinical management. Implantable loop recorders provided a diagnosis that altered clinical management in 22% of patients, with management changes being positively associated with increasing age.
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