Diagnostic yield of implantable loop recorders: Results from the Hellenic registry.

AIMS: 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. METHODS AND RESULTS: 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 established at 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% in presyncope/syncope group, 2.2% in palpitations group, and 3.7% in CS group in addition to oral anticoagulation initiation. CONCLUSIONS: In this real-world patient population, ILR determines diagnosis and initiates a new therapeutic management in nearly one fourth of patients. ILR implantation is valuable in the evaluation of patients with unexplained presyncope/syncope, CS and palpitations.

Electrophysiologic study and catheter ablation of a supraventricular tachycardia in a patient with inferior vena cava congenital anomaly.

Electrophysiologic procedures are performed widely nowdays, for the successful treatment of several cardiac arrhythmias. In this case report, we describe a rare congenital anomaly of the inferior vena cava, as an incidental finding during a scheduled electrophysiologic procedure for a supraventricular tachycardia ablation. The patient is a 32 year old male with an unremarkable medical history, suffering from sustained episodes of paroxysmal tachycardia. The electrophysiological maneuvers confirmed the presence of atrioventricular nodal reentry tachycardia, followed by a successful slow pathway ablation. We provide imaging details and guidance on the successful catheter positioning. In cases like this, the prognosis is excellent, while the follow up of our patient was unremarkable.