Background There are few reported studies evaluating the use of the implantable loop recorder for the investigation of syncope and palpitations in children.
Objective To evaluate use of the implantable loop recorder in children.
Setting Royal Hospital for Sick Children, Glasgow, UK
Method Retrospective study of children who had an implantable loop recorder between September 1998 and October 2005.
Results A total of 38 devices were implanted in 34 children. The median age at implantation was 11.3 years old (range 1.8 to 17.6 years). The median follow-up period was 15 months (range 2 to 58 months). The main presenting complaint was syncope in 26 (76.5%), seizures in 6 (17.6%) and palpitations in 2 (5.9%). After implantation, 19 (53%) patients had symptom recurrence. Of these, 11 were shown to have sinus rhythm during symptoms and 8 had an abnormal ECG. Four patients had asystole greater than 3 seconds and were diagnosed with reflex asystolic syncope. Two patients had polymorphic ventricular tachycardia. One was subsequently diagnosed with catecholaminergic polymorphic ventricular tachycardia and in the other results of genetic testing are awaited. Both of these patients had a history of syncope on exertion and one also had a family history of sudden death. One patient who already had a diagnosis of long QT syndrome was shown to have ventricular ectopy during symptoms and treated by increasing the dosage of beta-blocker. One patient had transient complete heart block during symptoms but refused a pacemaker. In almost half of the cases (44.1%), symptoms resolved after implantation. Complications requiring removal of the device occurred in 6 (15.8%) implants.
Conclusions In children with syncope and palpitations, the implantable loop recorder appears to be an excellent method of effecting a ‘cure’ in almost 50% of subjects. For those who remain symptomatic, it is very successful in determining cardiac rhythm during symptoms, but the complication rate in children may be higher than that of adults.
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