Discrepancy between clinical practice and standardized indications for an implantable loop recorder in patients with unexplained syncope.
OBJECTIVE
An implantable loop recorder (ILR) is indicated in patients with unexplained syncope after complete conventional work-up. Data from the literature imply that, in clinical practice, the ILR is underused. The aim of the study was to verify if there is any discrepancy between the use of ILRs in clinical practice and the potential indications based on the most potentially appropriate guideline indications.


RESULTS
We compared the prevalence of ILRs actually implanted in patients with unexplained syncope in the Syncope Unit Project (SUP) study and the potential one using the standard given by the guidelines. In the SUP study, 28 (18%) out of 159 patients with unexplained syncope received an ILR. Appropriate criteria for implantation of ILRs according to guidelines were present in 110 (69%) patients. Moreover, 7 (25%) of ILRs actually implanted did not satisfy the guideline standards. During the follow-up, 32% of patients who had received an ILR had a diagnosis compared with 5% of those who did not (P= 0.001).


CONCLUSIONS
The estimated indications were four times higher than those observed. Moreover, in about one quarter of the cases, the use of ILRs proved to be potentially inappropriate according to guideline indications. Two-thirds of patients with unexplained syncope had indications potentially appropriate for ILRs.
Vitale
Elena
E
Department of Emergency, Ospedale Antonio, Biagio e Cesare Arrigo, via Venezia #16, Alessandria, Italy. eelavit@libero.it
Ungar
Andrea
A
Maggi
Roberto
R
Francese
Maura
M
Lunati
Maurizio
M
Colaceci
Roberto
R
Del Rosso
Attilio
A
Castro
Antonio
A
Santini
Massimo
M
Giuli
Silvia
S
Belgini
Lara
L
Casagranda
Ivo
I
Brignole
Michele
M
D000368:Aged; D000369:Aged, 80 and over; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017410:Practice Guidelines as Topic; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology