Key result
ILR monitoring beyond 25 months shows reduced diagnostic yield except in Brugada syndrome.
Why the study?
Implantable loop recorders are effective for arrhythmia diagnosis, but the optimal follow-up duration across clinical indications remains uncertain.
Does prolonged implantable loop recorder monitoring beyond 25 months improve diagnostic yield in patients with syncope, palpitations, cryptogenic stroke, or Brugada syndrome?
Observational (n=1,500)
Yes
Does prolonged implantable loop recorder monitoring beyond 25 months improve diagnostic yield in patients with syncope, palpitations, cryptogenic stroke, or Brugada syndrome?
p-value: p=<0.001
Implantable loop recorder monitoring can be safely limited to 14-16 months for syncope, palpitations, and cryptogenic stroke, but prolonged monitoring beyond 25 months remains beneficial for Brugada syndrome.
May justify prolonged monitoring in syncope/palpitations; leaves open outcome benefits in prospective trials.
Background/Introduction Implantable loop recorders (ILRs) are effective tools for arrhythmia diagnosis, yet the optimal follow-up duration remains uncertain. Defining when to discontinue monitoring across clinical indications is crucial to optimize healthcare resources. Purpose To assess the time to diagnosis and diagnostic yield of ILRs by clinical indication, identifying patients who may benefit from monitoring beyond 25 months. Methods This multicenter retrospective study included 1,500 patients who received an ILR for syncope, palpitations, cryptogenic stroke, or Brugada syndrome. Time to diagnosis, clinically relevant events by indication, and the number needed to follow (NNF) were analyzed. The 25-month optimal cut-off was determined using maximal rank statistics. Results Most diagnoses occurred within 25 months for syncope (NNF: 3.54 vs ∞), palpitations (4.26 vs 25.33), and stroke (5.88 vs 19.07), with a significant drop in yield beyond this period (all p<0.001). Conversely, in Brugada syndrome, the diagnostic rate remained stable after 25 months (NNF: 9.82 vs 10.01; p=0.815), with late detection of ventricular tachycardia and pauses. Conclusions ILR monitoring can be safely limited to 14–16 months in most indications without diagnostic loss. However, prolonged follow-up remains beneficial in Brugada syndrome. These findings support a personalized, indication-based approach to ILR monitoring duration, enhancing clinical efficiency and resource use.
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Cocchiara et al. (2026) conducted an observational in Syncope, palpitations, cryptogenic stroke, or Brugada syndrome (n=1,500). Implantable loop recorder monitoring beyond 25 months vs. Monitoring within 25 months was evaluated on Time to diagnosis and diagnostic yield (p=<0.001). Implantable loop recorder monitoring beyond 25 months showed a significant drop in diagnostic yield for syncope, palpitations, and stroke (P<0.001), but remained stable in Brugada syndrome (P=0.815).
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