In adults with Fabry disease, clinically indicated implantable loop recorders detected arrhythmias requiring initiation or modification of therapy in 41% of patients.
Cross-Sectional (n=22)
Yes
Does implantable loop recorder (ILR) monitoring improve arrhythmia detection in adults with Fabry disease?
ILR implantation in adults with Fabry disease uncovers a high burden of clinically actionable arrhythmias, suggesting they may be underutilized in this high-risk population.
Fabry disease (FD) is an X-linked deficiency of alpha-galactosidase-A, leading to lysosomal storage of sphingolipids in multiple organs. Myocardial accumulation contributes to arrhythmia and sudden death, the most common cause of FD mortality. Therefore, there is a need for risk stratification and prediction to target device therapy. Implantable loop recorders (ILRs) allow for continual rhythm monitoring for up to 3 years. Here, we performed a retrospective study to evaluate current ILR utilisation in FD and quantify the burden of arrhythmia that was detected, which resulted in a modification of therapy. This was a snapshot assessment of 915 patients with FD across three specialist centres in England during the period between 1 January 2000 and 1 September 2022. In total, 22 (2.4%) patients underwent clinically indicated ILR implantation. The mean implantation age was 50 years and 13 (59%) patients were female. Following implantation, nine (41%) patients underwent arrhythmia detection, requiring intervention (six on ILR and three post-ILR battery depletion). Three patients experienced sustained atrial high-rate episodes and were started on anticoagulation. Three had non-sustained tachyarrhythmia and were started on beta blockers. Post-ILR battery depletion, one suffered complete heart block and two had sustained ventricular tachycardia, all requiring device therapy. Those with arrhythmia had a shorter PR interval on electrocardiography. This study demonstrates that ILR implantation in FD uncovers a high burden of arrhythmia. ILRs are likely to be underutilised in this pro-arrhythmic cohort, perhaps restricted to those with advanced FD cardiomyopathy. Following battery depletion in three patients as mentioned above, greater vigilance and arrhythmia surveillance are advised for those experiencing major arrhythmic events post-ILR monitoring. Further work is required to establish who would benefit most from implantation.
Roy et al. (Fri,) conducted a cross-sectional in Fabry disease (n=22). Implantable loop recorder (ILR) was evaluated on Arrhythmia detection requiring initiation or modification of therapy. In adults with Fabry disease, clinically indicated implantable loop recorders detected arrhythmias requiring initiation or modification of therapy in 41% of patients.