P5669Clinical management of syncope patients guided by insertable cardiac monitors in Europe

Abstract

Abstract Introduction Current European guidelines recommend the use of insertable cardiac monitors (ICMs) in the early phase of evaluation for patients with recurrent, unexplained syncope and a likelihood of recurrence during the device battery life. The ongoing Reveal LINQ Registry collects real-world data on clinical actions guided by the insertable cardiac monitor (ICM) in these patients. Purpose To characterize ICM-guided diagnosis and treatment of syncope patients in Europe. Methods The Reveal LINQ Registry is a prospective, observational, multi-center study evaluating real-world performance of the ICM. Patients from European centres who had syncope indicated as the reason for ICM implant were included in the analysis. Kaplan-Meier methods were used to determine the percentage of patients receiving treatment. Results In total, 139 patients from 12 centres [Portugal (78); The Netherlands (30); Belgium (12); Italy (10); Germany (5); United Kingdom (4)] received an ICM to monitor for unexplained syncope and had at least one follow-up visit. The mean age was 61.2 and 51.1% were female. During a mean follow-up time of 11.2 months, 31 patients experienced at least one recurrent syncope event classified as: cardiac (9), vasovagal (4), idiopathic (8) and unknown (10). An arrhythmia was diagnosed in 14 (45.2%) patients with a recurrent event and clinical actions were taken in 12 (38.7%) patients (10 IPGs, and 2 AF ablations). Among patients without a recurrence, 25 (23.1%) had an arrhythmia diagnosed and 20 (18.5%) had a clinical action taken (13 therapeutic device implants, 4 ablations, and 3 medication changes). Overall, the rate of clinical actions was 32.6% after 18 months of ICM follow-up in the unexplained syncope population (Figure). Time to treatment Conclusion Clinical actions are taken in approximately one third of unexplained syncope patients monitored with an ICM after 18 months of follow up. Acknowledgement/Funding Medtronic