CP25: IMPLANTABLE LOOP RECORDER FOR THE EVALUATION OF UNEXPLAINED SYNCOPE: DIAGMOSTIC CONTRIBUTION OF THE AUTOMATIC AND OF MANUAL ACTIVATION OF THE DEVICE

Aim Our experience with implantable loop recorder (ILR) for patients (pts) with unexplained syncope is reported, focusing on the relative diagnostic contribution of the manual and the automatic activation of the device. Methods According to the European Society of Cardiology Guidelines on Syncope, an ILR was reserved to: a) pts with structural heart disease and syncope unexplained after a complete diagnostic workup; b) pts without heart disease but with recurrent, severe syncope. Pts implanted with an ILR underwent elective controls every four months; further, urgent controls were planned in the case of syncope recurrence. Results Between 15/11/02 and 22/11/04, 14 pts (M/F 4/9, age 77±9, 8 with heart disease) were implanted with an ILR. After a 7±7 months follow-up, 25 elective and 5 urgent controls were performed. Among the 5 pts with syncope recurrence, only 2 were able to manually activate the device, and in both cases a bradyarrhythmia was detected. In further 2 pts the mechanism of syncope was detected by the automatic activation of the device corresponding to the spontaneous symptoms. During the elective controls further 239 automatic activations were detected, but none of these was diagnostic. Conclusions The findings from ILR were useful only in the case of symptom recurrence during the monitoring period, while the automatic activation in absence of symptoms was totally useless. Nevertheless, this latter function of the device was clinically relevant given the low patients' ability to manually activate the device after a spontaneous clinical event.