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Sakhi R, Kauling RM, Theuns DA, Szili-Torok T, Bhagwandien RE, van den Bosch AE, Cuypers JAAE, Roos-Hesselink JW, Yap SC. Early detection of ventricular arrhythmias in adults with congenital heart disease using an insertable cardiac monitor (EDVA-CHD study). Int J Cardiol 2020; 305:63-69. [PMID: 32057477 DOI: 10.1016/j.ijcard.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/27/2019] [Accepted: 02/03/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) due to ventricular arrhythmias (VA) is an important mode of death in adults with congenital heart disease (CHD). Risk stratification is difficult in this heterogeneous population. Insertable cardiac monitors (ICM) may be useful for risk stratification. The purpose of the present study was to evaluate the use of ICM for the detection of VA in adults with CHD. METHODS In this prospective single-center observational study we included consecutive adults with CHD deemed at risk of VA who received an ICM between March 2013 and February 2019. The decision to implant an ICM was made in a Heart Team consisting of a cardiac electrophysiologist and a cardiologist specialized in CHD. RESULTS A total of 30 patients (mean age, 38 ± 15 years; 50% male) received an ICM. During a median follow-up of 16 months, 8 patients (27%) had documented nonsustained VA. Of these 8 patients, 3 (10%) received a prophylactic ICD. Furthermore, ICM-detected arrhythmias were present in 22 patients (73%) leading to a change in clinical management in 16 patients (53%). Besides the patients receiving an ICD, 10 patients (33%) had a change in their antiarrhythmic drugs, 6 patients (20%) underwent an electrophysiology study, and 1 patient (3%) received a pacemaker. CONCLUSIONS The detection of VA by the ICM contributed to the clinical decision to implant a prophylactic ICD. Furthermore, ICM-detected arrhythmias led to important changes in the clinical management. Therefore, long-term arrhythmia monitoring by an ICM seems valuable for risk stratification in adults with CHD.
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Affiliation(s)
- Rafi Sakhi
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Abstract
OBJECTIVES To raise awareness among pediatric intensive care specialists of catecholaminergic polymorphic ventricular tachycardia; an uncommon cause of polymorphic ventricular tachycardia and ventricular fibrillation arrest in children and young adults where epinephrine (adrenaline), even when given according to international protocols, can be counter-productive and life-threatening. We review three cases of cardiac arrest in children, later proven to be catecholaminergic polymorphic ventricular tachycardia related, where delay in recognition of this condition resulted in significantly longer resuscitation efforts, more interventions, and a longer time to return of spontaneous circulation. DESIGN Retrospective case series. SETTING Tertiary children's hospital. PATIENTS AND RESULTS Three previously well children 4, 5, and 10 years old presented with cardiac arrest triggered by light activity, partial water immersion, and running, respectively. Initial resuscitation was bystander cardiopulmonary resuscitation and community defibrillation in all three cases. Electrocardiograms revealed multifocal ventricular ectopy, and in two (4 and 10 yr old), this correlated with repeated administration of epinephrine during repeated ventricular tachycardia and ventricular fibrillation cardiac arrest resuscitation cycles. This ultimately resolved immediately (at 78 and 140 min, respectively) with IV opiates once catecholaminergic polymorphic ventricular tachycardia was suspected. During recovery, on extracorporeal membrane oxygenation, epinephrine challenge in two children induced polymorphic ventricular tachycardia, bidirectional ventricular tachycardia, and ventricular fibrillation, which was cardioverted with flecainide in the 4-year-old. The third case was recognized early as catecholaminergic polymorphic ventricular tachycardia and was managed by avoiding epinephrine and using opiates and general anesthesia after the initial (single) cardioversion, and had a much better clinical course, without recourse to extracorporeal membrane oxygenation. All three carried de novo RyR2 (cardiac ryanodine) mutations. CONCLUSIONS Those involved in resuscitation of young people should be aware of catecholaminergic polymorphic ventricular tachycardia and be suspicious of persistent ventricular ectopy, polymorphic, or bidirectional ventricular tachycardia during resuscitation. Appropriate management is avoidance of epinephrine, administration of general anesthesia, IV opiates, and consideration of flecainide.
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Bieganowska K, Kaszuba A, Bieganowski M, Kaczmarek K. PocketECG: A New Noninvasive Method for Continuous and Real-Time ECG Monitoring-Initial Results in Children and Adolescents. Pediatr Cardiol 2017; 38:448-455. [PMID: 28101660 DOI: 10.1007/s00246-016-1534-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/12/2016] [Indexed: 11/24/2022]
Abstract
Long-term ECG is widely used in diagnosis and assessment of many cardiac symptoms which may be caused by dangerous arrhythmias that sometimes can be difficult to document. The PocketECG system is a new technological solution for a long-term, noninvasive, continuous and real-time ECG monitoring that provides automatic diagnosis of dysrhythmias. ECG data transmission occurs over a mobile network. The goal of this study was to assess the reliability of long-term ECG recordings acquired with the PocketECG system. One hundred and fifteen patients (43 girls and 72 boys) of an average age of 15.5 ± 2.5 years were examined at the Department of Cardiology at the Children's Memorial Health Institute. Two simultaneous 24-h ECG recordings were conducted: one with a Holter monitor and one with the PocketECG system. A linear correlation was demonstrated between the two methods with regard to the recorded QRS complexes [H = 1173.0 (-1946.40; 4838.50) + PocketECG*0.98 (0.94; 1.02)]. Mean diurnal heart rhythms were comparable (p > 0.05) despite the fact that the slowest and the fastest rates were different. The rate of detection for ventricular, supraventricular dysrhythmias and pauses in ventricular rhythm were comparable in both methods. The PocketECG system for continuous and real-time ECG recording is a reliable method for the assessment of heart rhythm and dysrhythmias in children and adolescents.
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Affiliation(s)
- Katarzyna Bieganowska
- Department of Cardiology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland.
| | - Agnieszka Kaszuba
- Department of Cardiology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Maciej Bieganowski
- Department of Arrhythmia, The Cardinal Stefan Wyszyński Institut of Cardiology, Alpejska 42 Str, 04-628, Warsaw, Poland
| | - Krzysztof Kaczmarek
- Clinical and Teaching Hospital Medical University of Lodz, 251 Pomorska St., 92-213, Lodz, Poland
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Galli A, Ambrosini F, Lombardi F. Holter Monitoring and Loop Recorders: From Research to Clinical Practice. Arrhythm Electrophysiol Rev 2016; 5:136-43. [PMID: 27617093 DOI: 10.15420/aer.2016.17.2] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages. This review discusses the advances in this area of arrhythmology and how Holter monitors have improved the clinical management of patients with suspected cardiac rhythm diseases.
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Affiliation(s)
- Alessio Galli
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Francesco Ambrosini
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Federico Lombardi
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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PLACIDI SILVIA, DRAGO FABRIZIO, MILIONI MADDALENA, VERTICELLI LETIZIA, TAMBURRI ILARIA, SILVETTI MASSIMOSTEFANO, DI MAMBRO CORRADO, RIGHI DANIELA, GIMIGLIANO FABRIZIO, RUSSO MARIOSALVATORE, PALMIERI ROSALINDA, REMOLI ROMOLO, SANTUCCI LORENZOMARIA, TOZZI ALBERTOEUGENIO. Miniaturized Implantable Loop Recorder in Small Patients: An Effective Approach to the Evaluation of Subjects at Risk of Sudden Death. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:669-74. [DOI: 10.1111/pace.12866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 01/23/2023]
Affiliation(s)
- SILVIA PLACIDI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - FABRIZIO DRAGO
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - MADDALENA MILIONI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - LETIZIA VERTICELLI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - ILARIA TAMBURRI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - MASSIMO STEFANO SILVETTI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - CORRADO DI MAMBRO
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - DANIELA RIGHI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - FABRIZIO GIMIGLIANO
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - MARIO SALVATORE RUSSO
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - ROSALINDA PALMIERI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - ROMOLO REMOLI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - LORENZO MARIA SANTUCCI
- Cardiac Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - ALBERTO EUGENIO TOZZI
- Telemedicine Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
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Ergul Y, Tanidir IC, Ozyilmaz I, Akdeniz C, Tuzcu V. Evaluation rhythm problems in unexplained syncope etiology with implantable loop recorder. Pediatr Int 2015; 57:359-66. [PMID: 25348219 DOI: 10.1111/ped.12530] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/27/2014] [Accepted: 10/16/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Syncope is a frequent complaint in children and adolescents and may be a significant sign of serious pathology. Although patient history, family history, and physical examination are sufficient to reach a diagnosis in most cases of syncope, the cause of syncope still cannot be determined after initial investigation in one-third to half of all patients. The aim of this study was to evaluate the diagnostic yield of implantable loop recorder (ILR) in children with unexplained syncope. METHODS A retrospective review was carried out of clinical data, indications, findings, and a final management strategy in patients who underwent ILR implantation. RESULTS A total of 12 patients with a mean age of 9.4 ± 4.5 years underwent ILR (Reveal Plus; Medtronic) implantation. ILR implantation indication was syncope in all of the patients. Family history, routine cardiac assessment, including resting 12-lead electrocardiogram, transthoracic echocardiography, 24 h Holter recording, and event recorder findings, were normal with the exception of one patient with (previously corrected) tetralogy of Fallot. After an average of 20 months (range, 1-36 months), six patients developed symptoms. ILR memory showed torsades de pointes-ventricular fibrillation (n = 3), catecholaminergic polymorphic ventricular tachycardia (n = 1), asystole and ventricular tachycardia (n = 1), and normal sinus rhythm (n = 1). At the time of writing six patients were still in follow up with no symptoms after an average of 25.2 months. CONCLUSION Implantable loop recorder plays an important role in the diagnosis of life-threatening arrhythmias in which syncope is otherwise unexplained. ILR implantation should be remembered in children whose symptoms are strongly correlated with rhythm disturbances.
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Affiliation(s)
- Yakup Ergul
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Ibrahim Cansaran Tanidir
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Celal Akdeniz
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Volkan Tuzcu
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
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Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11:e55-78. [PMID: 24814375 DOI: 10.1016/j.hrthm.2014.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Jane E Crosson
- Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David J Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anne Dubin
- Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California
| | | | - Susan Etheridge
- University of Utah and Primary Children's Medical Center, Salt Lake City, Utah
| | - Andrew Papez
- Phoenix Children's Hospital/Arizona Pediatric Cardiology Consultants Phoenix, Arizona
| | | | | | - Philip Saul
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | | | - William Stevenson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Zimmerman
- Advocate Heart Institute for Children Advocate Children's Hospital, Oak Lawn, Illinois.
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Abstract
Implantable loop recorders provide the highest sensitivity and accuracy of diagnosing cardiac arrhythmia that results in cardiac syncope. When bradyarrhythmia or tachyarrhythmia, including atrial fibrillation, is detected, appropriate secondary prevention therapy will be implemented, which will impact the long-term clinical outcome. An implantable loop recorder enables the clinician to record for a longer period of time, which increases the likelihood of detecting cardiac arrhythmia. Currently, this technology is being evaluated to diagnose a cardiac etiology of ischemic stroke and to optimize atrial fibrillation management that will predict the success of rhythm control and prevent thromboembolic events. This article reviews implantable loop recorder technology, and discusses the current indications, the outcomes of clinical studies and ongoing current studies, and future technological improvements.
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Affiliation(s)
- Mahmoud Houmsse
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Medical Center, Columbus, OH.
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Volosin K, Stadler RW, Wyszynski R, Kirchhof P. Tachycardia detection performance of implantable loop recorders: results from a large 'real-life' patient cohort and patients with induced ventricular arrhythmias. Europace 2013; 15:1215-22. [DOI: 10.1093/europace/eut036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 560] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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11
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2012; 127:e283-352. [PMID: 23255456 DOI: 10.1161/cir.0b013e318276ce9b] [Citation(s) in RCA: 378] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Salih H, Monsel F, Sergent J, Amara W. [Long-term follow-up after implantable loop recorder in patients with syncope: results of a French general hospital survey]. Ann Cardiol Angeiol (Paris) 2012; 61:331-7. [PMID: 23062819 DOI: 10.1016/j.ancard.2012.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/07/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite recent advances in diagnostic procedures, syncope remains unexplained in 15 to 35% of patients. If implantable loop recorder is a validated diagnostic tool for unexplained syncope, results of this strategy are largely issued from randomized studies. We lack the results of surveys. The aim of this study was to report a single center experience with implantable loop recorders, in patients with unexplained syncope. METHODS AND RESULTS A device (Medtronic Reveal DX or XT) was implanted in 31 patients between January 2009 and January 2012. During a mean follow-up of 10.5±8.5 months, loop recording definitively determined that an arrhythmia was the cause of symptoms in 10 patients (32%). Fourteen patients (45%) experienced syncope or pre-syncope. In eight of the 14 patients with syncope, during follow-up, no arrhythmic diagnosis could be made (one patient has been diagnosed as presenting epilepsy and seven as having hypotensive vasovagal syncope). In six patients, the ILR showed an arrhythmic aetiology. Four other patients presented an abnormal ILR result without symptoms. Diagnosis included sinusal arrest in four patients, bradycardia in one patient, advanced atrioventricular block in two patients, ventricular arrythmias in two patients, and supraventricular tachycardia of 180/min in one patient. Therapy was instituted in all patients, in whom an arrhythmic cause was found except one who refused the therapy (six pacemaker, two implantable cardioverter-defibrillator implantations, and one cryoablation of atrioventricular nodal reentrant tachycardia confirmed by an invasive exploration). CONCLUSION In this survey, implantable loop recorder implantation led to the diagnosis of an arrhythmic cause in 32% of patients and excluded an arrhythmic cause in 26% of patient with a mean follow-up of 10.5 months.
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Affiliation(s)
- H Salih
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
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AL DHAHRI KHALIDN, POTTS JAMESE, CHIU CHRISTINEC, HAMILTON ROBERTM, SANATANI SHUBHAYAN. Are Implantable Loop Recorders Useful in Detecting Arrhythmias in Children with Unexplained Syncope? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1422-7. [DOI: 10.1111/j.1540-8159.2009.02486.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brignole M, Vardas P, Hoffman E, Huikuri H, Moya A, Ricci R, Sulke N, Wieling W, Auricchio A, Lip GYH, Almendral J, Kirchhof P, Aliot E, Gasparini M, Braunschweig F, Lip GYH, Almendral J, Kirchhof P, Botto GL. Indications for the use of diagnostic implantable and external ECG loop recorders. Europace 2009; 11:671-87. [PMID: 19401342 DOI: 10.1093/europace/eup097] [Citation(s) in RCA: 222] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Kenny D, Chakrabarti S, Ranasinghe A, Chambers A, Martin R, Stuart G. Single-centre use of implantable loop recorders in patients with congenital heart disease. Europace 2009; 11:303-7. [DOI: 10.1093/europace/eun380] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schuchert A. [Event-recorder]. Herzschrittmacherther Elektrophysiol 2008; 19:130-6. [PMID: 18956159 DOI: 10.1007/s00399-008-0011-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/14/2008] [Indexed: 10/19/2022]
Abstract
Event or loop recorders monitor heart rhythm using discontinuous ECG storage which enables them to obtain a correlation between symptoms and the underlying heart rhythm in patients with infrequent, short-lasting episodes. External event recorders with intermittent monitoring, i.e., with electrodes within the device, are suitable for patients with palpitations or tachycardia who remain conscious. External event recorders with continuous monitoring are tolerated by patients for a few weeks and have a limited diagnostic impact in patients with recurrent syncope. The implantable loop recorder (ILR) monitors heart rhythm for one year and after patient-triggered or automatic activation stores a one-lead ECG up to 42 minutes prior to device activation. The diagnostic benefit of ILR in comparison to conventional approaches has been demonstrated in randomised studies. Furthermore, an ILR identifies patients with recurrent syncope of unknown origin in whom a pacemaker implantation can avoid further episodes. Additional possible indications are the monitoring of atrial fibrillation, the diagnostics of infrequent palpitations and patients with seizures.
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Affiliation(s)
- Andreas Schuchert
- Friedrich-Ebert-Krankenhaus, Medizinische Klinik, Friesenstr. 11, 24534 Neumünster, Deutschland.
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Brignole M, Bellardine Black CL, Thomsen PEB, Sutton R, Moya A, Stadler RW, Cao J, Messier M, Huikuri HV. Improved Arrhythmia Detection in Implantable Loop Recorders. J Cardiovasc Electrophysiol 2008; 19:928-34. [PMID: 18410328 DOI: 10.1111/j.1540-8167.2008.01156.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michele Brignole
- Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, Italy
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51:e1-62. [PMID: 18498951 DOI: 10.1016/j.jacc.2008.02.032] [Citation(s) in RCA: 1101] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350-408. [PMID: 18483207 DOI: 10.1161/circualtionaha.108.189742] [Citation(s) in RCA: 935] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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FRANGINI PATRICIAA, CECCHIN FRANK, JORDAO LIGIA, MARTUSCELLO MARIA, ALEXANDER MARKE, TRIEDMAN JOHNK, WALSH EDWARDP, BERUL CHARLESI. How Revealing Are Insertable Loop Recorders in Pediatrics? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:338-43. [DOI: 10.1111/j.1540-8159.2008.00995.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stephenson JBP. Clinical diagnosis of syncopes (including so-called breath-holding spells) without electroencephalography or ocular compression. J Child Neurol 2007; 22:502-8. [PMID: 17621539 DOI: 10.1177/0883073807301937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A recent article in this journal suggested that ocular compression during electroencephalography was useful in distinguishing "breath-holding spells and syncope" from epileptic seizures. The method proposed involved measurement of the RR interval on the simultaneously recorded electrocardiographic trace and determining both the absolute RR lengthening and the change in RR interval as compared with the baseline value. It is argued by the present author that this is not an appropriate way to come to a diagnosis in episodic loss of consciousness in children. It is pointed out that so-called "breath-holding spells" are reflex syncopes and that the diagnosis of reflex syncopes should be by clinical history, even if this means delaying the diagnosis until a future consultation. Published evidence on the nature and clinical diagnosis of reflex syncopes in infants and children is reviewed in depth. It is concluded that routine electroencephalography is not an appropriate investigation when the diagnosis of episodic loss of consciousness is in doubt and has the implicit danger of false positive "abnormality". Aside from scientific exploration of the developing autonomic nervous system, the only current indication for diagnostic ocular compression is to induce a syncope so that its nature may be better understood. Such a circumstance might be a history of an apparent reflex syncope but with atypical features, including prolonged post-syncopal unconsciousness such as might indicate epileptic absence status. Several additional investigations of a primarily cardiological nature may be indicated in some cases, but a wait-and-see policy is usually to be preferred.
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