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Implantable loop recorder: is remote monitoring an advantage?
Session:
Posters 2 - Écran 04 - Arritmologia - Dispositivos
Speaker:
Lucy Calvo
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.4 Home and Remote Patient Monitoring
Session Type:
Posters
FP Number:
---
Authors:
Lucy Calvo; Bebiana Faria; Margarida Oliveira; Pedro von Hafe; Sílvia Ribeiro; Bernardete Rodrigues; Assunção Alves; Victor Manuel Sanfins; Francisco Castro Ferreira; António Lourenço
Abstract
<p>Purpose: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important tool in the management of these patients.The authors aimed to evaluate the ILR indications, diagnostic yield, ILR-guided interventions, complications and the importance of remote monitoring in these devices.</p> <p>Methods: A retrospective study of all patients that underwent ILR implantation from April 2001 to June 2017 in our hospital, with a maximum follow-up period of 36 months.Information was collected on patient characteristics, indication for implant, the device type (with or without remote monitoring), results of prior investigations, complications, diagnostic outcome and subsequent management. The statistical analysis was performed with SPSS 21 version.</p> <p>Results: A total of 257 patients were included, 54% female, with a mean age of 65±16 years old. Previously to ILR implantation all patients had performed EKG, transthoracic echocardiogram and a 24h Holter, 12.5% Tilt test and 5.4% an electrophysiological study. The implantation indications were recurrent syncope in 86.4%, palpitations in 11.7% and ischemic stroke in five patients. In the majority of patients, 53.7%, a ILR with remote monitoring was implanted. Symptoms with related electrocardiographic events were recorded in 32% of the population (83 patients).</p> <p>The main arrhythmic disorders were sinus node dysfunction (55%) and atrioventricular conduction disturbance (19%); atrial fibrillation/atrial flutter was documented in 12% of patients, syncopal ventricular tachycardia in six patients, paroxysmal supraventricular tachycardia in four patients and one patient presented alternating bundle branch block. These findings have resulted in 63 permanent pacemakers and seven ICD implantations; introduction of chronic anticoagulation in four patients; four successful AVNRT ablation and orientation of three patients to Neurology due to suspicion of epilepsy. </p> <p>Of all diagnostic ILRs, duration of monitoring was less than 3 months for 36% (27/75), 3–6 months for 23% (17/75), 6–12 months for 23% (17/75), 12–24 months for 9% (7/75), and more than 24 months for 9% (7/75). Comparing the two groups, with and without remote monitoring, we realized that the existence of remote monitoring in the ILR is positively related with a shorter interval between the implant and the diagnosis (p =0.037).</p> <p>There were no major complications.</p> <p>Conclusion: ILR proved to be safe and efficient. It has enabled the identification of serious rhythm disturbances in 32% of patients, provided a targeted therapeutic intervention. We concluded that the presence of remote monitoring in the ILR was an advantage by shortening the time from the event to the diagnosis.</p>
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