Yield Of Implantable Loop Recorder Research Articles

Real-world evaluation of the treatment yield of implantable loop recorders (ILR) in the Netherlands

Abstract Background Implantable loop recorders (ILRs) are invasive and expensive diagnostic tools used to determine the underlying arrhythmias associated with syncope and palpitations as well as capture atrial fibrillation (AF). The diagnostic and treatment yield from ILRs is uncertain. Prior studies indicated that 26-52% ILR patients were diagnosed with arrhythmias and 11-30% received subsequent treatment. Purpose Our primary aim was to determine the incidence of pacemaker and ICD implants within 1- and 3- years of ILR implantation. The secondary aims include 1) an evaluation of the incidence of AF ablation, 2) the identification of predictors for treatment, and 3) safety. Methods Adult patients who underwent an ILR implant in the Netherlands Heart Registration (NHR) Pacemaker and ICD registry (2018-2021) were included. The NHR device registry was linked to the ablation registry to determine the incidence of AF ablation after ILR. Incidence rates for pacemaker implants, ICD implants, AF ablations, and complications among ILR patients were reported as a proportion of ILR patients over 1- and 3- years. Predictors for treatment following an ILR were determined from multivariable logistic regression models. Results From 2018 to 2021, 11,961 patients underwent an ILR implant in the Netherlands. Patients who underwent ILR implantation were a median age 69 (IQR 56-77) years, 46.9% female, and 24.9% had AF. The most frequent indication for ILR implantation was syncope (76.2%), followed by palpitations (15.2%). At 1- and 3-years post-ILR implantation, 12.0% and 14.6% of ILR patients underwent a pacemaker implant, respectively (Figure 1). Fewer patients underwent ICD implants (0.9% and 1.3%) and AF ablation (1.3% and 1.8%) at 1- and 3-years post-ILR implantation, respectively (Figure 1). Compared to males, females were 28% and 70% less likely to undergo a pacemaker and ICD implant following ILR, respectively (Figure 2). Additional predictors for pacemaker implantation included older age, AF, and syncope (p<0.05 for all, Figure 2a). In addition to female sex, AF was a predictor of ICD implantation (Figure 2b). The incidence of complications was relatively low (0.3%). Infection was the most frequent complication (0.2%), followed by device dislocation (0.06%), bleeding (0.02%), and device defect (0.01%). Conclusion Despite the benefits of ILRs for long-term remote monitoring, the therapeutic yield of ILRs is relatively low with 14.6%, 1.3%, and 1.8% of ILR patients undergoing implantation for pacemakers, ICDs, and AF ablation at 3-years follow-up. As an expensive and invasive diagnostic tool, a more targeted approach for referrals is warranted to increase the therapeutic yield of the ILRs. Further investigations are warranted to determine the diagnostic yield of ILRs, regardless of subsequent invasive therapy.

Diagnostic yield of implantable loop recorders: results from the hellenic registry

ObjectiveImplantable loop recorders (ILRs) are increasingly being used for long-term cardiac monitoring in different clinical settings. The aim of this study was to investigate the real-world performance of ILRs—including the time to diagnosis—in unselected patients with different ILR indications. Methods and ResultsIn this multicenter, observational study, 871 patients with an indication of pre-syncope/syncope (61.9%), unexplained palpitations (10.4%), and atrial fibrillation (AF) detection with a history of cryptogenic stroke (CS) (27.7%) underwent ILR implantation. The median follow-up was 28.8 ± 12.9 months. In the presyncope/syncope group, 167 (31%) received a diagnosis established by the device. Kaplan-Meier estimates indicated that 16.9% of patients had a diagnosis at 6 months, and the proportion increased to 22.5% at 1 year. Of 91 patients with palpitations, 20 (22%) received a diagnosis based on the device. The diagnosis was established in 12.2% of patients at 6 months, and the proportion increased to 13.3% at 1 year. Among 241 patients with CS, 47 (19.5%) were diagnosed with AF. The diagnostic yield of the device was 10.4% at 6 months and 12.4% at 1 year. In all cases, oral anticoagulation was initiated. Overall, ILR diagnosis altered the therapeutic strategy in 26.1% of the presyncope/syncope group, 2.2% of the palpitations group, and 3.7% of the CS group in addition to oral anticoagulation initiation. ConclusionIn this real-world patient population, ILR determines diagnosis and initiates new therapeutic management for nearly one-fourth of patients. ILR implantation is valuable in the evaluation of patients with unexplained presyncope/syncope, CS, and palpitations.

Diagnostic yield of implantable loop recorders in patients with unexplained syncope: single-center experience.

A significant proportion of patients have syncope of uncertain etiology. While implantable loop recorder (ILR) has become an important diagnostic tool in diagnosing syncope, its contemporary role in accordance with the recently updated syncope guidelines is not well established. The purpose of this single-center retrospective study was to determine the diagnostic yield of ILR in patients with unexplained syncope following initial diagnostic work-up as recommended by the guidelines. Medical records of 100 consecutive patients with syncope or presyncope who received ILR following the recently updated recommended diagnostic work-up were retrospectively evaluated. Seven patients were lost to follow-up (7%). During a median follow-up of 12 months (IQR 6.5-27.5), syncope or presyncope recurred in 61 patients (65.6%). In 37 (37/61, 60.7%), correlation between abnormal heart rhythm and symptoms was confirmed by ILR. Syncope was predominantly caused by bradyarrhythmia (33/37, 89.2%). Of the remaining four patients, three (8.1%) had ventricular tachycardia and one had atrial fibrillation with rapid ventricular response. Arrhythmogenic cause of syncope or presyncope was excluded in 24 patients (24/61, 39.3%) as no arrhythmia was recorded at the time of reported symptoms. Median time to establishing diagnosis was 354 days (171-783). The diagnostic yield of ILR after initial inconclusive recommended diagnostic work-up in accordance with the relevant guidelines was high. The findings affirm ILR as an important diagnostic tool in contemporary management of syncope.

Use, indications and diagnostic yield of implantable loop recorder in clinical practice: a single, high volume, tertiary care centre experience

Abstract Introduction Besides the established class I indication for the evaluation of patients with recurrent syncope of uncertain origin, implantable loop recorders (ILRs) have been increasingly used for other diagnostic purposes (e.g. detection of atrial fibrillation (AF) following cryptogenic stroke). Purpose To describe the main indications to ILR and to investigate procedural parameters, outcomes and diagnostic yield of ILR in a single, high-volume tertiary care centre. Methods All patients undergoing ILR implantation between October 2010 and October 2019 were consecutively enrolled in this study. Clinical characteristics of patients, procedural data and outcomes were collected. The indications to ILR implantation were divided into four categories: 1) AF detection in patients with recent cryptogenic stroke or peripheral thromboembolism [CRYSP], 2) recurrent syncope of uncertain origin [RSUO], 3) monitoring of ventricular arrhythmic events [VAE] in patients with predisposing cardiomyopathy/channelopathy, 4) monitoring of AF burden [AFB]. The main endpoint of the study was the diagnostic yield (number of definitive diagnoses made) and the time to diagnosis following ILR implantation. The occurrence of acute or subacute complications was used as a secondary safety endpoint. Results Overall, 1008 patients underwent ILR implantation (mean age 64 years, 43% female). The two main indications to ILR were AF detection following CRYSP and RSUO (41% and 34% of all implantations respectively, table 1). The commonest site of implantation was the left parasternal position (570 patients, 57%), median procedural time was 20 minutes (IQR 15–25). During a median follow-up of 580 days (186–1179), a definitive diagnosis was achieved in 366 (36%) patients after a median time of 208 days (IQR 59–515) [table 1 shows details and action taken following diagnosis for each indication subgroup]. Infections requiring ILR extraction or pocket revision occurred in 12 patients (1.2%). Conclusions In this cohort of patients use of ILR was associated with a good diagnostic yield regardless of the initial indication, triggered timely therapeutic actions and was overall safe. Funding Acknowledgement Type of funding source: None

Diagnostic yield of implantable loop recorders in patients with unexplained syncope: single-centre experience

A significant proportion of patients have syncope of uncertain etiology. While implantable loop recorder (ILR) has become an important diagnostic tool in diagnosing syncope, its contemporary role in accordance with the recently updated syncope guidelines is not well established. The purpose of this single-center retrospective study was to determine the diagnostic yield of ILR in patients with unexplained syncope following initial diagnostic work-up as recommended by the guidelines. Medical records of 100 consecutive patients with syncope or presyncope who received ILR following the recently updated recommended diagnostic work-up were retrospectively evaluated. Seven patients were lost to follow-up (7%). During a median follow-up of 12 months (IQR 6.5-27.5), syncope or presyncope recurred in 61 patients (65.6%). In 37 (37/61, 60.7%), correlation between abnormal heart rhythm and symptoms was confirmed by ILR. Syncope was predominantly caused by bradyarrhythmia (33/37, 89.2%). Of the remaining four patients, three (8.1%) had ventricular tachycardia and one had atrial fibrillation with rapid ventricular response. Arrhythmogenic cause of syncope or presyncope was excluded in 24 patients (24/61, 39.3%) as no arrhythmia was recorded at the time of reported symptoms. Median time to establishing diagnosis was 354 days (171-783). The diagnostic yield of ILR after initial inconclusive recommended diagnostic work-up in accordance with the relevant guidelines was high. The findings affirm ILR as an important diagnostic tool in contemporary management of syncope.

The diagnostic yield of implantable loop recorders stratified by indication: "real-world" use in a large academic hospital.

To report on the clinical utility of implantable loop recorders (ILRs) in a large academic hospital setting over a 4-year period. Retrospective study (2013-2016) of patients receiving ILRs for any indication including syncope, cryptogenic stroke (CrS), atrial fibrillation (AF) burden, palpitations, ventricular arrhythmias (VA), and other. Remote checks, symptomatic transmissions, and in-person checks were reviewed. Time to diagnosis was documented. A total of 263 patients (54% male, mean age 63 ± 15years, mean follow-up 601 (range 9-1714) days) received ILRs for 324 indications; multiple indications were noted in 53/263 (20.2%) patients. ILR indications were 126 (39%) syncope, 81 (25%) CrS, 46 (14%) AF, 37 (11%) palpitations, 10 (3%) VA, and 24 (7%) other. Diagnostic yield for each indication was compared to the overall yield for all other indications. Three indications showed a significantly higher yield: AF (65% vs. 22%, p<0.002), palpitations (60% vs. 24%, p<0.001), and VA (70% vs. 28%, p<0.004). For all other indications, there were no significant differences. Syncope had nearly half the diagnostic yield of previously published trials (28% vs. 43-56%). We observed a fourfold increase in ILR implant rate over the study duration. In a "real-world" academic hospital setting, the diagnostic rate of ILRs was highest for AF, palpitations, and VA; however, these high yield indications comprised only 29% of all indications. The diagnostic yield for the commonest indication (syncope) was approximately half that reported in the previously published trials. With increasing implantation rates, additional studies are required to refine guideline-based indications for ILR implantation to improve diagnostic yield.

P6561Diagnostic yield of implantable loop recorders: a comparison of arrhythmia nurse specialists versus clinicians

Abstract Background Implantable loop recorders (ILR) are recommended in guidelines to determine symptom-rhythm correlation. Arrhythmia Nurse Specialists (ANS) play a critical role in the assessment of such patients. Their effectiveness at risk stratification for ILR implantation is unknown. The ESC 2018 Syncope guidelines recommend more research in this field. Aim To evaluate the diagnostic yield of consecutive ILR implants at a tertiary centre over a 2year period and compare ANS versus Clinicians. Methods A retrospective study of all patients undergoing ILR implant between April 2016 and April 2018. Data collected included baseline patient demographics, referral source and management changes made by ILR findings. Results 305 patients had an ILR; median age was 71yrs (interquartile range 52–81), 55% male. Median follow-up time was 15months. Referrals were from general cardiology (GC) = 98 (32%), electrophysiology (EP) = 105 (34%), and ANS-led syncope clinic = 102 (34%). Indications for ILR implant were syncope = 203 (65.9%), palpitation = 21 (6.9%), pre-syncope = 16 (5.2%), cryptogenic stroke = 35 (11.5%) and others 7 (8.9%) (falls, channelopathies). Of the entire cohort, 102 (34.0%) experienced arrhythmias recorded on the ILR that resulted in a change of management. This included: pacemaker implant = 49 (16.1%), complex-device implant = 7 (2.3%), AF=28 (9.2%), SVT=14 (4.6%), VT=1 (0.3%). Of those with a syncope indication (n=203), findings on ILR altered management in 73patients (36.0%) over a median follow-up of 18months; a pacing indication in this syncope group was present in 44 (21.9%) patients (median time to diagnosis: 2.7 months) with 24 receiving a pacemaker indication within 3 months of ILR insertion. ANS had a higher pacemaker implant rate. Overall, an ILR resulted in a diagnostic yield of 34.1% (n=104). Specialist nurse referral resulted in an overall greater trend towards change of management in 38.2% of patients compared with GC (32.7%) and EP (31.0%) (p=0.593 nurse vs. consultant). Conclusion The overall diagnostic yield of ILR insertion was 34% in our study. ANS had a trend towards a greater diagnostic yield compared with clinicians, and significantly more pacemaker indications. Our data suggests that ANS patient selection for ILR insertion are at least comparable to clinicians.

Yield of implantable loop recorder in detection of atrial fibrillation after embolic stroke of undetermined source: A single center experience

Yield of implantable loop recorder in detection of atrial fibrillation after embolic stroke of undetermined source: A single center experience

P418Contemporary diagnostic yield of implantable loop recorders in patients from Northwestern Greece in the setting of economic crisis

P418Contemporary diagnostic yield of implantable loop recorders in patients from Northwestern Greece in the setting of economic crisis

Abstract WMP61: Predictors of Diagnostic Yield of Implanted Loop Recorder in Patients With Cryptogenic Stroke: a Systemic Review and Meta-analysis

Background: Implantable Loop Recorders (ILR) are increasingly being used for detection of atrial fibrillation (AF) after cryptogenic stroke (CS). There is limited data on determinants of diagnostic yield in this population. Objective: To systematically review prior available trials studying ILRs in CS to look for predictors of diagnostic yield of ILR over time. Methods: We searched MEDLINE and Cochrane Central Register of Controlled Trials. We included studies of ILRs on patients who presented with acute CS. We excluded studies which did not analyze baseline characteristics of patients with and without AF detection. Results: Our search revealed six prospective studies which met inclusion criteria with a total of 344 patients. All patients had at least 24 hour ambulatory EKG prior to ILR implantation. The mean duration of ILR monitoring was 445.2 days. On an average 24.4% of patients had new AF detected with an average time to detection of 85.5 days. Table 1 shows summary statistics and meta-analysis combinations of studies. Comparing covariates among patients with and without AF detection, a basic combination of individual study p-values (Z score) revealed age, CHADS-Vasc score, left atrial (LA) volume and ectopy to be significantly different in the two groups. Analyzing significance with χ 2 combination methods and combinations of effect size values suggested only CHADS-Vasc score to be significant. Ectopy was presented in terms of burden of APCs in two studies which showed significant difference between groups; and in terms of proportions of cases with “excessive” atrial ectopy in two other studies which did not show significance. Conclusions: Overall AF was detected in 24.4% of patients with ILR implantation after CS. CHADS-Vasc score was found to be a significant predictor in detecting AF. Older age, increased LA volumes and excessive ectopy on holter were found to be significant in some studies but on overall computation did not show statistical significance.

The diagnostic yield of implantable loop recorders in unexplained syncope: A systematic review and meta-analysis

BackgroundGuidelines recommend that implantable loop recorders (ILRs) are used in the evaluation of people with recurrent unexplained syncope in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. The aim of this systematic review was to analyze the diagnostic yield of ILRs in these patients. MethodsWe performed a systematic search in order to retrieve studies enrolling adults undergoing ILR implantation for undetermined syncope. The primary outcome was the overall diagnostic yield, defined as the proportion of patients with syncope recurrence and an available ILR recording or an automatic detection of a significant arrhythmia. Secondary outcomes were the proportions of patients with the specific etiologic diagnoses on the total of subjects and the proportion of an analyzable ECG recording during symptoms. We used a random effects model for the meta-analyses. ResultsForty-nine studies, enrolling 4381 subjects, were included. The overall diagnostic yield was 43.9% (95% CI=40.2%, 47.6%; I2=79.8%). The proportions of subjects finally diagnosed with arrhythmic syncope, ventricular arrhythmias, supraventricular arrhythmias and bradyarrhythmias were 26.5%, 2.7%, 4.9% and 18.2%, respectively. The proportion of an analyzable ECG recording during symptoms was 89.5% (95% CI=86.1%, 92.1%; 1236 subjects; 36 studies; I2=44.9%). Median time to diagnosis was 134days. Heterogeneity is an important limitation to be acknowledged. ConclusionsAbout a half of unexplained syncope subjects implanted with an ILR were diagnosed, and around 50% of them had an arrhythmia. Life-threatening arrhythmias as well as ILR complications and death due to arrhythmic events were very rare.

Evaluation rhythm problems in unexplained syncope etiology with implantable loop recorder.

Syncope is a frequent complaint in children and adolescents and may be a significant sign of serious pathology. Although patient history, family history, and physical examination are sufficient to reach a diagnosis in most cases of syncope, the cause of syncope still cannot be determined after initial investigation in one-third to half of all patients. The aim of this study was to evaluate the diagnostic yield of implantable loop recorder (ILR) in children with unexplained syncope. A retrospective review was carried out of clinical data, indications, findings, and a final management strategy in patients who underwent ILR implantation. A total of 12 patients with a mean age of 9.4 ± 4.5 years underwent ILR (Reveal Plus; Medtronic) implantation. ILR implantation indication was syncope in all of the patients. Family history, routine cardiac assessment, including resting 12-lead electrocardiogram, transthoracic echocardiography, 24 h Holter recording, and event recorder findings, were normal with the exception of one patient with (previously corrected) tetralogy of Fallot. After an average of 20 months (range, 1-36 months), six patients developed symptoms. ILR memory showed torsades de pointes-ventricular fibrillation (n = 3), catecholaminergic polymorphic ventricular tachycardia (n = 1), asystole and ventricular tachycardia (n = 1), and normal sinus rhythm (n = 1). At the time of writing six patients were still in follow up with no symptoms after an average of 25.2 months. Implantable loop recorder plays an important role in the diagnosis of life-threatening arrhythmias in which syncope is otherwise unexplained. ILR implantation should be remembered in children whose symptoms are strongly correlated with rhythm disturbances.

Diagnostic Yield of Implantable Loop Recorders in Patients with Unexplained Syncope

of patients in sinus rhythm at one and two year follow up. These results are comparable to international reports. Follow up at 12 months Follow up at ≥24 months Total (n= 65) Paroxysmal AF (n= 37) Nonparoxysmal AF (n= 28) Total (n= 36) Paroxysmal AF (n= 20) Nonparoxysmal AF (n= 16) Success without drugs Single procedure (%) 53.8 56.8 50.0 50.0 55.0 43.8 Success with or without drugs Single procedure (%) 58.5 59.5 57.1 50.0 55.0 43.8 Success without drugs ≥1 procedure (%) 69.2 67.6 71.4 69.4 70.0 68.8 Success with or without drugs ≥1 procedure (%) 89.2 91.9 85.7 86.1 90.0 81.3 http://dx.doi.org/10.1016/j.hlc.2012.03.098 Diagnostic Yield of Implantable Loop Recorders in Patients with Unexplained Syncope J. Swampillai ∗, R.F. Allen, S. Levings, M.R.Webber, C.M. Wade, M.K. Stiles, S.C. Heald Department of Cardiology, Waikato Hospital, Hamilton, New Zealand Background: The implantable loop recorder (ILR) is a subcutaneous, electrocardiographic monitoring device used for diagnosis in patients with recurrent, infrequent Use of Exercise Tolerance Test in Intermediate Risk nonST Elevation Acute Coronary Syndrome P. Tamuno ∗, J. Mazhar, J. Swampillai, V. Pera, A. Kerr, G. Devlin Department of Cardiology, Waikato Hospital, Hamilton, New Zealand Background: Exercise tolerance test (ETT) is recommended for initial risk stratification in patients with Non ST Elevation Acute Coronary Syndrome (NSTEACS) in the absence of high risk features. We reviewed current practice at Waikato Hospital, the regional tertiary centre. Methods:FromtheACUTEPREDICTregistrywe identified 716 patients admitted with NSTEACS and TIMI score 0–4 between January 2008 and January 2010. After excluding143patientswhoweremanagedmedically (20%)due to co-morbidities, the remaining 573 patients were analysed in two groups: Group A had ETT prior to angiography; Group B had angiography without ETT. Results: There were 244 (43%) patients in Group A (mean age 64± 12 years, 72% males) and 329 (57%) in Group B (mean age 64± 13 years, 66% males). Compared togroupA,GroupBhadmorepatientswithTIMI score 3–4 (63%vs. 53%,P= 0.02) andNSTEMI (66%vs. 44%,P≤ 0.01). Results are summarised in the tables below. Only 20% of patients risk-stratified by ETT did not undergo inpatient angiography (Tables 1 and 2). symptoms with a suspected arrhythmic aetiology. We aimed to establish the diagnostic yield of ILR in patients with unexplained syncope. Methods: We identified all patients who had an ILR implanted at Waikato Hospital from March 2007 to November 2011. Previous investigations, arrhythmias detected by the device and outcomes were recorded. Results: Thirty-one patients (17 men; mean age 46± 24 years) underwent ILR implantation. The mean number of cardiac investigations prior to ILR was 4± 1; duration of implant 16± 12 months. Arrhythmias were detected in 13 patients; eight tachycardias, five bradycardias. Time to diagnosis was 7± 6 months and specific treatment was guided by ILR analysis in these patients. Pacemakers were implanted in four patients, two received implantable cardioverter defibrillators, two were given anti-arrhythmic drugs, four had an electrophysiological study (two were normal and two underwent catheter ablation). Neurocardiogenic syncope was diagnosed in one patient and symptoms resolved. Sinus rhythm was documented during syncope in five patients. Death from non-arrhythmic causes occurred in twopatients (onemyocardial infarction and cardiogenic shock, one stroke). No arrhythmias have been detected so far in 11 patients remaining under follow up (mean implant duration 9± 7 months). Conclusion: More than half of patients had an arrhythmic causeof syncopediagnosed (13) or excluded (5) by ILR. This confirms their usefulness in selected patients with unexplained syncope despite normal preliminary investigations. http://dx.doi.org/10.1016/j.hlc.2012.03.099 Table 1. Summary of coronary interventions and outcomes. Group A N= 244 Group B N= 329 P value Inpatient angiogram 195 (80%) 329 (100%) <0.01 PCI 109 (45%) 180 (55%) 0.02 CABG 23 (9%) 24 (7%) NS Length of stay in days (mean±SD) 6.8± 6 6.1± 5 0.09 Stroke/TIA (in-hospital) 0 3 Death (in-hospital) 1 1 Table 2. Angiograms performed in relation to ETT results. Positive ETT N= 167 (68%) Negative ETT N= 42 (18%) Inconclusive ETT N= 35 (14%) In-patient angiogram, N (%) 159 (95%) 10 (24%) 26 (74%) Angiogram in 6-month F/U, N (%) 6 (4%) 7 (17%) 2 (6%) Conclusions: The majority of patients admitted with NSTEACS and TIMI score ≤4 underwent inpatient angiography regardless of the use of ETT as a risk stratification tool for intermediate risk scores. No difference was evident in early events. http://dx.doi.org/10.1016/j.hlc.2012.03.100

The diagnostic yield from implantable loop recorders in children and young adults

Syncope and palpitations occur frequently in young patients. Noninvasive diagnostic testing may be inconclusive. To assess the diagnostic yield of implantable loop recorders in young patients. Thirty-three young patients underwent implantation of a loop recorder for long-term monitoring of cardiac rhythm, to establish symptom-rhythm correlation. They belonged to one of three subgroups: those with structurally normal heart, normal electrocardiogram at rest, and negative family history (n = 16); patients with structural heart disease and previous surgical repair (n = 11), and patients with proven or suspected primary electrical disease (n = 6). A combination of automatic and patient-activated recordings was used to monitor cardiac rhythm during symptomatic episodes. There were no procedural complications. Diagnostic electrograms could be obtained in all patients. A high degree of symptom-rhythm correlation was established. In 8/33 patients, no recurrence of symptoms was observed either until end of battery life of the device (n = 4) or until last follow-up (n = 2). Specific cardiac therapy was required, based on rhythms recorded by the device in 15 patients (until last follow-up). This consisted of catheter ablation of a tachyarrhythmia (n = 7), pacemaker implantation or upgrade (n = 5) or ICD implantation (n = 5). In the remaining patients (n = 10), recurrence of symptoms was associated with a normal electrocardiogram, and in two of these patients a non-cardiac diagnosis was made. In selected patients, the implantable loop recorder provides valuable diagnostic information to guide further therapy.

734 Diagnostic yield of implantable loop recorder after a standardized work-up in patients with unexplained syncope

734 Diagnostic yield of implantable loop recorder after a standardized work-up in patients with unexplained syncope

734 Diagnostic yield of implantable loop recorder after a standardized work-up in patients with unexplained syncope

734 Diagnostic yield of implantable loop recorder after a standardized work-up in patients with unexplained syncope