Implantable Loop Recorder Allows an Etiologic Diagnosis in One-Third of Patients: – Results of the Spanish Reveal Registry –
Open accessAbstract
BACKGROUND: The implantable loop recorder (ILR) is a useful tool for diagnosing paroxysmal conditions potentially related to arrhythmias. Most investigations have focused on selected clinical studies or high-volume centers. The aim of this study was to evaluate the indications and outcomes of the ILR in real clinical practice. METHODS AND RESULTS: This was a prospective, multicenter registry of patients undergoing ILR implantation for clinical indications (April 2006-December 2008). Clinical characteristics (symptoms, arrhythmias, treatments) were recorded in a database. Follow-up data at 1 year or after the occurrence of the first episode were also recorded. Total enrollment: 743 patients (male, 413, 55.6%; 64.9 ± 16 years); 228 (30.7%) had structural heart disease (SHD), and 183 (24.6%), bundle branch block (BBB). Recurrent syncope (76.4%) was the most common indication for implantation. Complete follow-up was obtained for 680 patients (91.5%). Three hundred and twenty-five patients (48%) presented 414 events, with a final diagnosis in 230 patients (70.8% of patients with events; 33.1% of patients with follow-up). Syncope secondary to bradyarrhythmia was the most frequent diagnosis. Similar rates of final diagnoses were noted in subgroups of SHD, BBB and normal heart. Regarding the cause of implantation, higher event rates were registered among patients with recurrent syncope. CONCLUSIONS: One-third of patients obtained a final diagnosis with the ILR, independent of the baseline characteristics. Only the cause of implantation provided different rates of final diagnosis.
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In patients with recurrent syncope of uncertain origin, absence of high-risk criteria and structural heart disease, and in suspected reflex syncope, an asystolic pause was present during syncope in about 50% of patients.
“Similar findings were subsequently observed with ILR use expanded in an early phase of evaluation in patients with recurrent syncope of uncertain origin, in the absence of highrisk criteria and structural heart disease, 176,180-183 and in suspected reflex syncope. 184-186 In particular, an asystolic pause was present during syncope in about 50% of these patients.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [183]
Table 3 in the Subgroup Analysis reports bradycardia during syncope in 95 of 187 patients (50.8%), and the paper includes a normal-heart subgroup with many patients implanted for recurrent syncope. It does not identify those bradycardic events as asystolic pauses or establish the 50% figure specifically for patients without high-risk criteria or for suspected reflex syncope. No page number is available in our copy. (LLM, conf=0.84)
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- Authors
- Lacunza-Ruiz, F. J., Moya-Mitjans, A., Martínez-Alday, J., Barón-Esquivias, G., Ruiz-Granell, R., Rivas-Gándara, N., González-Enríquez, S., Leal-del-Ojo, J., F. Arcocha-Torres, M., Pérez-Villacastín, J., Garcia-Heil, N., & García-Alberola, A.
- Affiliations
- Hospital Universitario Virgen de la Arrixaca
- Hospital Universitario Valld´Hebron, Universidad Autónoma de Barcelona
- Hospital de Basurto (ES)
- Hospital Virgen del Rocío
- Hospital Clínico de Valencia
- Hospital Marqués de Valdecilla
- Hospital Universitario de Valme (ES)
- Hospital de Basurto/Clínica Vicente San Sebastian
- Hospital Clínico de Madrid
- Scientific and Clinical Department Medtronic Iberica SA
- Venue
- Circulation Journal
- Publisher
- Japanese Circulation Society
- Published
- 2013
- Volume
- 77
- Issue
- 10
- Pages
- 2535-2541
- ISSN
- 1346-9843 (ISSN-L)
- 1347-4820
- OpenAlex
- W1967384512
- Cited by
- 34
- References
- 26
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 2 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 3 · 2015: 4 · 2014: 4
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Circulation Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sociedad Española de Cardiología
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- implantable loop recorder, recurrent syncope, paroxysmal arrhythmias, bradycardia, structural heart disease, bundle branch block, etiological diagnosis, diagnostic yield, event detection
- MeSH terms
- Aged, Aged, 80 and over, Arrhythmias, Cardiac, Electrodes, Implanted, Female, Humans, Male, Middle Aged, Prospective Studies, Registries, Retrospective Studies, Spain, Databases, Factual
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