Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T14:10:27.241Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of the implantable loop recorder in children and adolescents

Published online by Cambridge University Press:  20 November 2006

Matthias Gass ,
Christian Apitz ,
Schahriar Salehi-Gilani ,
Gerhard Ziemer  and
Michael Hofbeck
Matthias Gass
Affiliation:
Department of Pediatric Cardiology, Children's Hospital, University of Tuebingen, Germany
Christian Apitz
Affiliation:
Department of Pediatric Cardiology, Children's Hospital, University of Tuebingen, Germany
Schahriar Salehi-Gilani
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Children's Hospital, University of Tuebingen, Germany
Gerhard Ziemer
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Children's Hospital, University of Tuebingen, Germany
Michael Hofbeck
Affiliation:
Department of Pediatric Cardiology, Children's Hospital, University of Tuebingen, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: Recurrent but infrequent syncopes represent a diagnostic challenge, since they frequently remain unexplained despite extensive investigations. This applies specifically for patients who carry an increased risk of potentially lifethreatening arrhythmias, either due to congenital cardiac disease or primary electrical disorders. Implantable loop recorders permit long-term electrocardiographic monitoring. Experience with these devices is still limited in children. Patients and methods: Between January 1999 and August 2005, 12 patients underwent implantation of a loop recorder in our tertiary referral centre. The mean age was 10.9 years, with a range from 2 to 17 years. Of the patients, 6 had structural disease, 3 had primary electrical abnormalities, and 3 had no cardiovascular disease. Results: Resyncope occured in 9 of the 12 patients. Arrhythmic origin of the syncope was diagnosed in 4 of these patients. The events recorded were ventricular fibrillation in 2, intermittent asystole in 1, and pacemaker-syndrome in the other patient. Malignant arrhythmia was ruled out in the remaining 5 patients. There were no complications related to implantation of the loop recorder, and the mean duration until explantation was 8.3 months. Conclusions: Based on our experience, we suggest that implantation of a loop recorder represents an additional tool for a selected group of children. Due to its invasive nature, it should be restricted to patients at high risk, or those in which there is substantial clinical suspicion of the likelihood of serious arrhythmias when conventional testing has been inconclusive. In this cohort, implantation of the loop recorder either helps to establish the correct diagnosis, or to exclude an arrhythmic event, thus avoiding unnecessary escalation of therapy and providing reassurance for the family.

Keywords

Syncopeimplantable loop recorderpaediatricarrhythmiaventricular fibrillation
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 6 , December 2006 , pp. 572 - 578
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ashby DT, Cehic DA, Disney PJ, Mahar LJ, Young GD. A retrospective case study to assess the value of implantable loop recorder for the investigation of undiagnosed syncope. Pacing Clin Electrophysiol 2002; 25: 1200–1205.Google Scholar
Krahn AD, Klein GJ, Yee R, Takle-Newhouse T, Norris C. Use of an extended monitoring strategy in patients with problematic syncope. Reveal investigators. Circulation 1999; 26: 406–441.Google Scholar
Moya A, Brignole M, Menozzi C, et al. International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation 2001; 104: 1261–1267.Google Scholar
Seidl K, Rameken M, Breunung S, et al. Reveal-Investigators. Diagnostic assessment of recurrent unexplained syncope with a new subcutaneously implantable loop recorder. Europace 2000; 2: 256–262.Google Scholar
Bloemers BL, Sreeram N. Implantable loop recorders in pediatric practice. J Electrocardiol 2002; 35: 131–135.Google Scholar
Rossano J, Bloemers B, Sreeram N, Balaji S, Shah MJ. Efficacy of implantable loop recorder in establishing symptom-rhythm correlation in young patients with syncope and palpitations. Pediatrics 2003; 112: 228–233.Google Scholar
Sanatani S, Peirone A, Chiu C, Human DG, Gross GJ, Hamilton RM. Use of an implantable loop recorder in the evaluation of children with congenital heart disease. Am Heart J 2002; 143: 366–372.Google Scholar
Ormaetxe JM, Saez R, Arkotxa MF, Martinez-Alday JD. Catecholaminergic polymorphic ventricular tachycardia detected by an insertable loop recorder in a pediatric patient with exercise syncopal episodes. Pediatr Cardiol 2004; 25: 693–695.Google Scholar
Schuller H, Brandt J. The pacemaker syndrome: old and new causes. Clin Cardiol 1991; 14: 336–340.Google Scholar
Chalvidan T, Deharo JC, Djiane P. Pacemacer syndromes. Ann Cardiol Angeiol (Paris) 2000; 49: 224–229.Google Scholar
Eckardt L, Probst V, Smits JPP, et al. Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome. Circulation 2005; 111: 257–263.Google Scholar
Rolf S, Bruns HJ, Wichter T, et al. The ajmaline challenge in Brugada syndrome: diagnostic impact, safety and recommended protocol. Eur Heart J 2003; 24: 1104–1112.Google Scholar
Driscoll DJ, Jacobsen SJ, Porter CJ, Wollen PC. Syncope in children and adolescents. J Am Coll Cardiol 1997; 29: 1039–1045.Google Scholar
Pratt JL, Fleisher GR. Syncope in children and adolescents. Pediatr Emerg Care 1989; 5: 80–82.Google Scholar
Krongrad E. Syncope and sudden death. In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgesell HP (eds). Heart disease in infants, children, and adolescents. Williams and Wilkins, Baltimore, 1995, pp 1604–1619.
Benditt DG, Lurie KG, Fabian WH. Clinical approach to diagnosis of syncope: an overview. Cardiol Clin 1997; 15: 165–176.Google Scholar
Garson A Jr, Dick M 2nd, Fournier A, et al. The long QT syndrome in children: an international study of 287 patients. Circulation 1993; 87: 1866–1872.Google Scholar
Seipel L, Borggrefe M, Horstkotte D, Kühlkamp V, Ostermeyer J. Heart arrhythmia following surgery of congenital heart defects. Z Kardiol 1989; 78: 53–64.Google Scholar
Tanel RE, Walsh EP. Syncope in the pediatric patient. Cardiol Clin 1997; 15: 277–294.Google Scholar
Grubb BP, Kosinski D. Tilt table testing: concepts and limitations. Pacing Clin Electrophysiol 1997; 20: 781–797.Google Scholar
Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med 1994; 97: 78–88.Google Scholar
Klein GJ, Gersh BJ, Yee R. Electrophysiological testing: the final court of appeal for diagnosis of syncope? Circulation 1995; 92: 1332–1335.Google Scholar
Muller T, Roy D, Talajic M, Lemery R, Nattel S, Cassidy D. Electrophysiologic evaluation and outcome of patients with syncope of unknown origin. Eur Heart J 1991; 12: 139–143.Google Scholar
Kapoor WN. Evaluation and management of the patient with syncope. JAMA 1992; 268: 2553–2560.Google Scholar
Brown AP, Dawkins KD, Davies JG. Detection of arrhythmias: use of a patient activated ambulatory electrocardiogram device with a solid state memory loop. Br Heart J 1987; 58: 251–253.Google Scholar
Linzer M, Pritchett ELC, Pontinen M, Mc Carthy E, Divine GW. Incremental diagnostic yield of loop electrocardiographic recorders in unexplained sincope. Am J Cardiol 1990; 66: 214–219.Google Scholar
Kapoor WN. Evaluation and outcome of patients with syncope. Medicine 1990; 69: 160–175.Google Scholar
Di Marco JP. Value and limitations of electrophysical testing for syncope. Cardiol Clin 1997; 15: 219–232.Google Scholar
Krahn AD, Klein GJ, Norris C, Yee R. The etiology of syncope in patients with negative tilt table and electrophysiological testing. Circulation 1995; 92: 1819–1824.Google Scholar
Krahn AD, Klein GJ, Yee R, Norris C. Final results from a pilot study with an implantable loop recorder to determine the etiology of syncope in patients with negative noninvasive and invasive testing. Am J Cardiol 1998; 82: 117–119.Google Scholar
Apitz C, Gass M, Dornberger V, Kuehlkamp V, Hofbeck M. The use of implantable cardioverter-defibrillators (ICD) in children and adolescents. Klin Padiatr 2006; 218: 270–275.Google Scholar