title: Differences in the yield of the implantable loop recorder between secondary and tertiary centers.
abstract: BACKGROUND
  The implantable loop recorder (ILR) is a useful tool for diagnosis of syncope or palpitations. Its easy use and safety have extended its use to secondary hospitals (those without an Electrophysiology Lab). The aim of the study was to compare results between secondary and tertiary hospitals.
  
  
  METHODS
  National prospective and multicenter registry of patients with an ILR inserted for clinical reasons. Data were collected in an online database. The follow-up ended when the first diagnostic clinical event occurred, or 1 year after implantation. Data were analyzed according to the center of reference; hospitals with Electrophysiology Lab were considered Tertiary Hospitals, while those hospitals without a lab were considered Secondary Hospitals.
  
  
  RESULTS
  Seven hundred and forty-three patients (413 [55.6%] men; 65 ± 16 year-old): 655 (88.2%) from Tertiary Centers (TC) and 88 (11.8%) from Secondary Centers (SC). No differences in clinical characteristics between both groups were found. The electrophysiologic study and the tilt table test were conducted more frequently in Tertiary Centers. Follow-up was conducted for 680 (91.5%) patients: 91% in TC and 94% in SC. There was a higher rate of final diagnosis among SC patients (55.4% vs. 30.8%; p < 0.001). Tertiary Hospital patients showed a trend towards a higher rate of neurally mediated events (20% vs. 4%), while bradyarrhythmias were more frequent in SC (74% vs. 60%; p = 0.055). The rate of deaths and adverse events was similar in both populations.
  
  
  CONCLUSIONS
  Patients with an ILR in SC and TC have differences in terms of the use of complementary tests, but not in clinical characteristics. There was a higher rate of diagnosis in Secondary Hospital patients.
authors.affiliation: Hospital Universitario Virgen de la Arrixaca Murcia. javierlacunzaruiz@gmail.com.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Lacunza-Ruiz
authors.forename: Angel
authors.initials: A
authors.lastname: Moya-Mitjans
authors.forename: Jesús
authors.initials: J
authors.lastname: Martínez-Alday
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Barón-Esquivias
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ruiz-Granell
authors.forename: Nuria
authors.initials: N
authors.lastname: Rivas-Gándara
authors.forename: Susana
authors.initials: S
authors.lastname: González-Enríquez
authors.forename: Juan
authors.initials: J
authors.lastname: Leal-del-Ojo
authors.forename: Natalie
authors.initials: N
authors.lastname: García-Heil
authors.forename: Arcadi
authors.initials: A
authors.lastname: García-Alberola
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D004567:Electrodes, Implanted; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D063728:Secondary Care Centers; D012815:Signal Processing, Computer-Assisted; D013030:Spain; D013575:Syncope / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D013686:Telemetry / Q000295:instrumentation*; D062606:Tertiary Care Centers; D018667:Tilt-Table Test