Key result
ILR remote monitoring is linked to a ~153% increase in arrhythmia evaluations vs in-office visits.
Why the study?
Data were limited on whether remote monitoring of implantable loop recorders confers enhanced diagnostic power in patients with unexplained syncope.
Does remote monitoring of implantable loop recorders reduce the time to diagnosis of clinically relevant arrhythmias in patients with unexplained syncope?
Cohort (n=241)
Open-label
Yes
Does remote monitoring of implantable loop recorders reduce the time to diagnosis of clinically relevant arrhythmias in patients with unexplained syncope?
Hazard Ratio: 2.53 (95% CI 1.32–4.86)
Absolute Event Rate: 28.6% vs 20.4%
p-value: p=0.005
Remote monitoring of implantable loop recorders in patients with unexplained syncope significantly reduces the time to clinical evaluation of relevant arrhythmias compared to standard biannual in-office visits.
May accelerate arrhythmia evaluation in unexplained syncope; hypothesis-generating and requires randomized confirmation before practice change.
Background There are little data on remote monitoring (RM) of implantable loop recorders (ILRs) in patients with unexplained syncope and whether it confers enhanced diagnostic power. Objective To evaluate the effect of RM in ILR recipients for unexplained syncope for early detection of clinically relevant arrhythmias by comparison with a historical cohort with no RM. Methods SyncRM is a propensity score (PS)-matched study prospectively including 133 consecutive patients with unexplained syncope and ILR followed up by RM (RM-ON group). A historical cohort of 108 consecutive ILR patients with biannual in-hospital follow-up visits was used as control group (RM-OFF group). The primary endpoint was the time to the clinician's evaluation of clinically relevant arrhythmias (types 1, 2, and 4 of the ISSUE classification). Results The primary endpoint of arrhythmia evaluation was reached in 38 patients (28.6%) of the RM-ON group after a median time of 46 days (interquartile range, 13–106) and in 22 patients (20.4%) of the RM-OFF group after 92 days (25–368). The PS-matched adjusted ratio of rates of arrhythmia evaluation was 2.53 (95% confidence interval, 1.32–4.86) in the RM-ON vs. RM-OFF group ( p = 0.005). Conclusion In our PS-matched comparison with a historical cohort, RM of ILR patients with unexplained syncope was associated with a 2.5-fold higher chance of evaluations of clinically relevant arrhythmias as compared with biannual in-office follow-up visits.
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Russo et al. (2023) conducted a cohort in Unexplained syncope (n=241). Remote monitoring of implantable loop recorders vs. Biannual in-hospital follow-up visits was evaluated on Time to the clinician's evaluation of clinically relevant arrhythmias (HR 2.53, 95% CI 1.32-4.86, p=0.005). Remote monitoring of implantable loop recorders in patients with unexplained syncope increased the rate of clinical evaluation for relevant arrhythmias by 2.5-fold (HR 2.53) compared to biannual in-office visits.
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