Aparecium—Reveal Yourself! A Two-year, Single-center Experience with Implantable Loop Recorders

Background: Establishing a correct diagnosis of “red-flag” syncope and cardiac rhythm disorders is crucial. However, in the pediatric population, this is challenging, time- and resource-consuming, and maybe even frustrating. Implantable loop recorders (ILRs) deliver a valuable tool in selected cases to confirm or rule out underlying arrhythmias.

Methods: ILR indication were either “red-flag” syncope with negative electroencephalogram (EEG), cranial MRI, and repetitive Holter electrocardiogram (h-ecg) or palpitation/tachycardia with repetitive negative h-ecg, whenever a wearable device was not applicable.

Results: Twenty-three ILRs were implanted between 2022 and 2024, the mean age was 14 years (range 5–20), thereof 15 females (65%) and 8 males (35%). The main indication was syncope (n = 15, 65%) or tachycardia (n = 8, 35%). Seven (45%) of the syncope subgroup had previous ECG abnormalities, which could not be clearly classified as coincidental occurrences or causes. Asystole-causing syncope was confirmed in two patients. In one patient an intermittent second-degree AV-Block could be excluded from causing convulsive syncope and epilepsy was finally confirmed. One patient was diagnosed with posttraumatic stress disorder and cardiac syncope could be ruled out. We detected four atrioventricular reentry and three atrial tachycardias. Twelve patients remain still under surveillance.

Conclusion: By nature, the detection rate in palpitations is very high and ILR comprises a feasible and safe approach when wearable devices are not applicable. Identifying cardiac origin in syncope is of utmost importance to guide therapy and prevent sudden death. Therefore even—or indeed especially—in the pediatric population, ILRs are a valuable, feasible, time-saving, and safe diagnostic tool to reveal the cardiac culprit in syncope and palpitation.

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Artikel online veröffentlicht:
11. Februar 2025