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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
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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

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