49 Diagnostic yield of implantable loop recorders: a comparison of arrhythmia nurse specialists versus clinicians

Abstract

Background and aims Syncope guidelines recommend Implantable loop recorders (ILR) to aid symptom-rhythm correlation. Arrhythmia Nurse Specialists (ANS) are important in assessment of these patients. Their effectiveness at risk stratification is unknown. ESC 2018 Syncope guidelines recommend more research. Our aim was to evaluate the diagnostic yield of all consecutive ILR implants over a 2-year period and compare ILR-guided management changes between ANS and clinicians. Methods Retrospective study of consecutive patients undergoing ILR implant between April 2016-April 2018, including baseline patient demographics, referral source and management changes made by ILR findings. Results 305 ILR patients were identified: median age 71 yrs (interquartile range 52–81), 45% female, median follow-up time 15months. Referrals were from general cardiology (GC)=98 (32%), electrophysiology (EP)=105 (34%) and ANS-led syncope clinic=102 (34%). Indications were syncope=203 (65.9%), palpitation=21 (6.9%), pre-syncope=16 (5.2%), cryptogenic stroke=35 (11.5%) and other reasons 7 (8.9%) (falls, channelopathies). Overall, 102 (34.0%) experienced arrhythmias detected on ILR that resulted in a change of management including: pacemaker implant=49 (16.1%), complex-device implant=7 (2.3%) and AF=28 (9.2%), SVT=14 (4.6%), VT=1 (0.3%). ANS referrals resulted in greater trend towards change of management (38.2%) of patients compared with GC (32.7%) and EP (31.4%) (p=0.593 nurse vs. consultant). For those needing pacing, 24 were from ANS referrals compared to 25 for clinicians (23.5% vs 18.3% respectively, p=0.012). Median time to developing a pacing indication was 2.6 months for ANS and 4.1 months for clinicians; 25 had pacing indication within 3 months of ILR insertion. Overall, an ILR had a diagnostic yield of 34.1% (n= 104) (table 1). Conclusion The diagnostic yield of ILR insertion was 34%. ANS referrals trended towards greater diagnostic yield compared with clinicians and significantly more pacemaker indications. Our data suggest ANS patient selection for ILRs are at least comparable to clinicians. Conflict of Interest None