Key result
Continuous monitoring with an implantable loop recorder detected clinically significant arrhythmias in 63% of patients with a systemic right ventricle, prompting management changes.
Why the study?
Patients with systemic right ventricles face high sudden cardiac death risk from arrhythmias, but routine Holter monitoring is opportunistic with poor adherence.
Does continuous rhythm monitoring with an implantable loop recorder allow early detection of clinically important arrhythmias in patients with systemic right ventricles following atrial switch repair?
Cohort (n=24)
Does continuous rhythm monitoring with an implantable loop recorder allow early detection of clinically important arrhythmias in patients with systemic right ventricles following atrial switch repair?
Continuous monitoring with an implantable loop recorder in patients with a systemic right ventricle detects clinically relevant arrhythmias that impact clinical decision-making, irrespective of baseline sudden cardiac death risk.
ILR may enable earlier arrhythmia detection in systemic RV patients; hypothesis-generating and requires prospective trials before routine adoption.
AIMS: Patients with systemic right ventricles are at high risk of sudden cardiac death. Arrhythmia is a significant risk factor. Routine Holter monitoring is opportunistic with poor adherence. The aim of this study was to determine if continuous rhythm monitoring with an implantable loop recorder (ILR) could allow early detection of clinically important arrhythmias. METHODS AND RESULTS: Implantable loop recorder implantation was offered to patients with atrial switch repair for transposition of the great arteries. Recordings were made with symptoms or, automatically for pauses, significant bradycardia or tachycardia and reviewed by the multi-disciplinary team. Twenty-four out of 36 eligible patients underwent ILR implantation with no complication. Forty-two per cent had preserved ventricular function, 75% were NYHA functional class I, 88% had low sudden cardiac death risk, 33% had previous intra-atrial re-entrant tachycardia (IART), and none had known conduction disease. Eighteen out of 24 (75%) patients made 52 recordings (52% automated) over 39.5 months (1.6-72.5). Thirty-two out of 52 (62%) recordings in 15/24 (63%) of the cohort were clinically significant and included sinus node disease (two patients), atrioventricular block (two patients), IART (seven patients), and IART with sinus node disease or atrioventricular block (four patients). Implantable loop recorder recordings prompted medication change in 11 patients [beta-blockers (n = 9), anti-coagulation (n = 5), and stopping anti-coagulation (n = 1)] and device therapy recommendation in seven patients [five pacemakers (three: atrioventricular block) and two defibrillators]. Two patients declined intervention; one suffered an arrhythmic death. Intra-atrial re-entrant tachycardia and clinically relevant conduction disease were detected in patients irrespective of sudden cardiac death risk. CONCLUSION: Continuous monitoring with an ILR in patients with systemic right ventricle following atrial switch detects clinically relevant arrhythmias that impact decision-making. In this cohort, clinically relevant arrhythmias did not correlate with sudden cardiac death risk.
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Kakarla et al. (2023) conducted a cohort in Systemic right ventricle (n=24). Implantable loop recorder (ILR) was evaluated on Detection of clinically important arrhythmias. Continuous monitoring with an implantable loop recorder detected clinically significant arrhythmias in 63% of patients with a systemic right ventricle, prompting management changes.
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