Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
William Harvey Heart Centre, Queen Mary University of London, Charterhouse Square, London EC1A 6BQ, UK.
Eur Heart J Qual Care Clin Outcomes. 2022 Oct 26;8(7):770-777. doi: 10.1093/ehjqcco/qcab071.
Implantable loop recorders (ILRs) are now routinely implanted for long-term cardiac monitoring in the clinical setting. The aim of this study was to examine the real-world performance of these devices focusing on the management changes made in response to ILR-recorded data.
This was a single-centre, prospective observational study of consecutive patients undergoing ILR implantation. All patients who underwent implantation of a Medtronic Reveal LINQ device from September 2017 to June 2019 at Barts Heart Centre were included. Five hundred and one patients were included. Three hundred and two (60%) patients underwent ILR implantation for an indication of pre-syncope/syncope, 96 (19%) for palpitations, 72 (14%) for atrial fibrillation (AF) detection with a history of cryptogenic stroke, and 31 (6%) for high risk of serious cardiac arrhythmia. The primary outcome of this study was that an ILR-derived diagnosis altered management in 110 patients (22%). Secondary outcomes concerned subgroup analyses by indication: in patients who presented with syncope/pre-syncope, a change in management resulting from ILR data was positively associated with age [hazard ratio (HR) 1.04, 95% confidence interval 1.02-1.06; P < 0.001] and negatively associated with a normal electrocardiogram at baseline (HR 0.54 [0.31-0.93]; P = 0.03). Few patients (1/57, 2%) aged <40 years in this group underwent device implantation, compared to 19/62 patients (31%) aged 75 years and over (P = 0.0024). Out of 183 (12%) patients, 22 in the 40-74 age range had a device implanted. Among patients who underwent ILR insertion following cryptogenic stroke, 13/72 (18%) had AF detected, leading to a decision to commence anticoagulation.
These results inform the utility of ILR in the clinical setting. Diagnoses provided by ILR that lead to changes in management are rare in patients under age 40, particularly following syncope, pre-syncope, or palpitations. In older patients, new diagnoses are frequently made and trigger important changes in treatment.
植入式循环记录器（ILR）目前已常规用于临床进行长期心脏监测。本研究旨在通过观察 ILR 记录数据所引发的管理变更，来评估这些设备的实际性能。
这是一项在巴茨心脏中心连续入组接受 ILR 植入患者的单中心前瞻性观察性研究。研究纳入 2017 年 9 月至 2019 年 6 月期间所有接受美敦力 Reveal LINQ 设备植入的患者。共纳入 501 例患者。320 例（60%）患者因晕厥/先兆晕厥而植入 ILR，96 例（19%）因心悸，72 例（14%）因有隐源性卒中病史且检测到心房颤动（AF）而植入 ILR，31 例（6%）因有发生严重心律失常的高风险而植入 ILR。本研究的主要结局为 110 例（22%）患者的 ILR 诊断改变了治疗方案。次要结局涉及按适应证进行的亚组分析：在因晕厥/先兆晕厥而就诊的患者中，ILR 数据导致的治疗方案变更与年龄呈正相关[风险比（HR）1.04，95%置信区间 1.02-1.06；P<0.001]，与基线时心电图正常呈负相关（HR 0.54 [0.31-0.93]；P=0.03）。在此组中，仅 1/57 例（2%）年龄<40 岁的患者接受了设备植入，而 62 例（31%）年龄 75 岁及以上的患者接受了设备植入（P=0.0024）。在 183 例（12%）患者中，40-74 岁年龄范围的患者中有 22 例植入了设备。在因隐源性卒中而接受 ILR 植入的 72 例患者中，有 13 例（18%）检测到 AF，从而决定开始抗凝治疗。
这些结果为 ILR 在临床环境中的应用提供了信息。在 40 岁以下的患者中，特别是在晕厥、先兆晕厥或心悸后，由 ILR 提供的导致治疗方案变更的诊断较为少见。在老年患者中，经常会做出新的诊断，并引发重要的治疗改变。
