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The implantable loop recorder in children: searching for indications
  1. Robert H Pass,
  2. Leonardo Liberman
  1. Pediatric Arrhythmia Service, Department of Pediatrics, NY Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA
  1. Dr L Liberman, New York Presbyterian Hospital, Columbia University, Pediatric Cardiology, 3959 Broadway Ave 2-North, New York, NY 10032, USA; ll202{at}columbia.edu

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Assessment of the aetiology of syncope in children can be challenging. In the majority of cases, the cause can be determined from a careful personal and family history, and physical examination. Additional testing such as an ECG, stress test, Holter monitoring and echocardiogram are useful in helping to ferret out the aetiology of syncope. Tilt table testing is also occasionally considered in patients with histories that are consistent with possible neurocardiogenic syncope. An invasive electrophysiological study is indicated when an arrhythmia is suspected, particularly in a patient with structural heart disease.1 Despite extensive investigations, there are rare cases in which the mechanism of syncope cannot be easily determined.

The implantable loop recorder (ILR) can be used as a diagnostic tool in cases of recurrent syncope in which an aetiological origin cannot be found.2 It is a device placed in the subcutaneous tissue, usually in the pectoral area, which can monitor heart rhythm continuously. In the case of an event, such as syncope, the rhythm can be automatically or manually stored by applying a hand-held activator over the device. Subsequently, the stored rhythm can be reviewed by the doctor.

Over the past decade, use of the ILR in adult patients has improved our ability to demonstrate symptom–rhythm correlation during infrequent episodes of unexplained syncope.35 In an international study, Brignole et al demonstrated that 74% of patients with recurrent syncope after ILR implant had documentation of the rhythm at the time of symptoms. Furthermore, treatment …

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