title: Miniaturized Implantable Loop Recorder in Small Patients: An Effective Approach to the Evaluation of Subjects at Risk of Sudden Death.
abstract: BACKGROUND
  The etiological diagnosis of syncope and/or palpitations in children is often challenging. However, when noninvasive conventional examinations are inconclusive, the subcutaneous miniaturized implantable loop recorder (ILR) is recommended. The aim of our study was to evaluate the efficacy of miniaturized cardiac implantable devices in the early diagnosis of arrhythmias in children ≤6 years.
  
  
  METHODS
  From March 2014 to May 2015, 21 patients (median age 5 years) underwent implantation of miniaturized ILR at our Institution after a complete cardiac work up. Median follow-up was 10 months.
  
  
  RESULTS
  One patient underwent device removal for pocket infection and one needed a pocket revision. Eleven (52%) patients did not show any symptom and/or arrhythmia. Eight patients experienced symptoms during ILR monitoring: six had no electrocardiographic abnormalities, two had significant sinus pauses. Two patients had significant arrhythmias without symptoms and in one of these a pacemaker was implanted. The overall diagnostic yield was 47%.
  
  
  CONCLUSIONS
  Miniaturized ILR could be very useful to make a diagnosis and to decide future management strategies in small patients with undefined symptoms or severe cardiac diseases. Considering its characteristics, miniaturized ILR could start a new era in the diagnosis and follow-up of young patients with symptomatic and/or malignant arrhythmias.
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Placidi
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Milioni
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Verticelli
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tamburri
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Massimo Stefano
authors.initials: MS
authors.lastname: Silvetti
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: DI Mambro
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Righi
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gimigliano
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Mario Salvatore
authors.initials: MS
authors.lastname: Russo
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Palmieri
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Romolo
authors.initials: R
authors.lastname: Remoli
authors.affiliation: Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Lorenzo Maria
authors.initials: LM
authors.lastname: Santucci
authors.affiliation: Telemedicine Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Alberto Eugenio
authors.initials: AE
authors.lastname: Tozzi
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D042241:Early Diagnosis; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D019736:Prostheses and Implants; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity
keywords: arrhythmias; children; implantable loop recorder; palpitations; syncope