Letsas Konstantinos P, Saplaouras Athanasios, Mililis Panagiotis, Kariki Ourania, Bazoukis George, Archontakis Stefanos, Anagnostopoulos Ioannis, Triantafyllou Sokratis, Palaiodimou Lina, Chatziantoniou Anastasios, Lykoudis Anastasios, Mpatsouli Athena, Katsa Georgia, Kadda Olga, Dragasis Stylianos, Cheilas Vasileios, Tsetika Eleftheria Garyfalia, Asvestas Dimitrios, Korantzopoulos Panagiotis, Poulos George, Maounis Themistocles, Kostopoulou Anna, Kossyvakis Charalambos, Xydonas Sotirios, Giannopoulos Georgios, Papagiannis John, Tsoutsinos Alexandros, Sidiropoulos George, Vassilikos Vassilios, Fragakis Nikolaos, Tzeis Stylianos, Deftereos Spyridon, Dilaveris Polychronis, Sideris Skevos, Efremidis Michael, Tsivgoulis Georgios
Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece.
Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece.
Hellenic J Cardiol. 2024 May 9. doi: 10.1016/j.hjc.2024.05.004.
Implantable loop recorders (ILRs) are increasingly being used for long-term cardiac monitoring in different clinical settings. The aim of this study was to investigate the real-world performance of ILRs-including the time to diagnosis-in unselected patients with different ILR indications.
In this multicenter, observational study, 871 patients with an indication of pre-syncope/syncope (61.9%), unexplained palpitations (10.4%), and atrial fibrillation (AF) detection with a history of cryptogenic stroke (CS) (27.7%) underwent ILR implantation. The median follow-up was 28.8 ± 12.9 months. In the presyncope/syncope group, 167 (31%) received a diagnosis established by the device. Kaplan-Meier estimates indicated that 16.9% of patients had a diagnosis at 6 months, and the proportion increased to 22.5% at 1 year. Of 91 patients with palpitations, 20 (22%) received a diagnosis based on the device. The diagnosis was established in 12.2% of patients at 6 months, and the proportion increased to 13.3% at 1 year. Among 241 patients with CS, 47 (19.5%) were diagnosed with AF. The diagnostic yield of the device was 10.4% at 6 months and 12.4% at 1 year. In all cases, oral anticoagulation was initiated. Overall, ILR diagnosis altered the therapeutic strategy in 26.1% of the presyncope/syncope group, 2.2% of the palpitations group, and 3.7% of the CS group in addition to oral anticoagulation initiation.
In this real-world patient population, ILR determines diagnosis and initiates new therapeutic management for nearly one-fourth of patients. ILR implantation is valuable in the evaluation of patients with unexplained presyncope/syncope, CS, and palpitations.
植入式环路记录仪（ILR）在不同临床环境中越来越多地用于长期心脏监测。本研究的目的是调查ILR在未选择的具有不同ILR适应症患者中的实际性能，包括诊断时间。
在这项多中心观察性研究中，871例有先兆晕厥/晕厥指征（61.9%）、不明原因心悸（10.4%）以及有隐源性卒中（CS）病史且需检测房颤（AF）（27.7%）的患者接受了ILR植入。中位随访时间为28.8±12.9个月。在先兆晕厥/晕厥组中，167例（31%）通过该设备获得确诊。Kaplan-Meier估计显示，16.9%的患者在6个月时得到诊断，1年时这一比例增至22.5%。在91例心悸患者中，20例（22%）通过该设备获得诊断。6个月时12.2%的患者得到诊断，1年时这一比例增至13.3%。在241例CS患者中，47例（19.5%）被诊断为房颤。该设备在6个月时的诊断率为10.4%，1年时为12.4%。在所有病例中，均开始口服抗凝治疗。总体而言，除开始口服抗凝治疗外，ILR诊断改变了先兆晕厥/晕厥组26.1%、心悸组2.2%以及CS组3.7%患者的治疗策略。
在这一真实世界患者群体中，ILR为近四分之一的患者确定了诊断并启动了新的治疗管理。ILR植入在评估不明原因先兆晕厥/晕厥、CS和心悸患者中具有重要价值。
