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Diagnostic yield and clinical implications of implantable loop recorder for arrhythmia investigation: a single center experience
Session:
Comunicações Orais - Sessão 15 - Fibrilhação Auricular e Flutter atípico
Speaker:
ANTONIO PINHEIRO CUMENA CANDJONDJO
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.9 Atrial Fibrillation - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pinheiro Candjondjo; Leonor Parreira; Dinis Mesquita; Ana Fátima Esteves; Joana Silva Ferreira; Jéni Quintal; Rui Antunes Coelho; Pedro Amador; Rita Marinheiro; José Farinha; Artur Lopes; Rui Caria
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> Implantable loop recorders (ILR) are indicated in a variety of clinical situations for continuous cardiac monitoring and have become an important diagnostic tool in detecting infrequent cardiac arrhythmias. We intended to analyze ILR indications, effectiveness and diagnostic yield in a single center experience. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> In this retrospective observational single-center study we included patients who received the ILR from october 2013 to november 2022. All patients were provided with the remote monitoring system. The primary endpoint was events detected by the ILR, either automatically or triggered by the patient and the secondary endpoint was a change in the clinical management after the event detection.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: This study included 142 patients (mean age 63.02 ± 15 years, 46.5% men). The most frequent indications for ILR implantation were unexplained syncope, n=91 (64.1%), non-documented palpitations, n=32 (22.5%) and screening for suspected undiagnosed paroxysmal atrial fibrillation (AF), n=8 (5.6%). During a mean follow-up of 23.0±25.2 months (range 0-105 months), the primary endpoint was met in 69 (48.6%) patients with a time to diagnosis of 10.8 ± 10.5 months (range 0-42 months) and the secondary endpoint in 53 (37.3%) patients. Overall, atrial fibrillation was the most common event recorded, n=35 (24,6%), followed by sinus pause, n=28 (19,7%), while atrio-ventricular block and atrial flutter were recorded in n=3 (2,1%) and n=3 (2,1%), respectively. Among patients with unexplained syncope, the most common events were sinus pause, n= 23 (25,3%) and AF, n=17 (18,7%). Regarding changes in clinical management following an event detection the most frequent intervention was starting or changing anti-arrhythmic drug treatment, n=33 (23%), followed by starting anticoagulation drug treatment, n=21 (15%), pacemaker implantation, n=17 (12%) and electrophysiology study/ablation procedure, n=17 (12%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During the follow-up, all-cause hospital admission rate was 20.4% (n=29), with only one recorded cardiovascular admission, and all-cause mortality rate was 7% (n=10), with no cardiovascular deaths recorded.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>The ILR is a valuable tool for the diagnosis of undocumented suspected arrhythmic events, often leading to a change in the clinical management of the patient. </span></span></p>
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