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It can be challenging to identify whether an arrhythmia was the cause of a fall or syncopal event, particularly in older adults who have a high frequency of unexplained falls. Conditions such as orthostatic hypotension and vasovagal syncope are common, and many patients provide other provide plausible excuses for the fall that may or may not be correct. Diagnosis of elusive cardiac arrhythmias requires detection of intermittent infrequent events yet there has been little evidence to support widespread use of implantable loop recorders (ILR). In a detailed study using ILR in 70 patients (mean age of 70 years) with 2 or more unexplained falls, Bhangu and colleagues (see page 681) found that the fall could be attributed to a cardiac arrhythmia in 20%, detected an average of 47.3 days, with a range of 1 to 190 days, after ILR implantation (figure 1). This data resulted in 14% receiving a permanent pacer for bradycardia or asystole and 6% being treated medically for a supraventricular tachycardia. An additional 34% of patients had modifications to their medical therapy based on an arrhythmia detected on ILR.
Although this is a small observational study, the implications of these results are profound, especially in an era when it is likely that everyone soon will be able to monitor their own …