An unmet need: arrhythmia detection by implantable loop recorder in the systemic right ventricle

Author:

Kakarla Jayant1ORCID,Crossland David S12,Murray Stephen3,Adhvaryu Kaitav12ORCID,Jansen Katrijn12ORCID,Rybicka Justyna12,Hermuzi Antony12ORCID,Martin Ruairidh3,Shepherd Ewen3,Seller Neil12ORCID,Coats Louise12ORCID

Affiliation:

1. Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne NE7 7DN , UK

2. Population Health Sciences Institute, Newcastle University , Newcastle upon Tyne NE1 7RU , UK

3. Cardiology Department, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne NE7 7DN , UK

Abstract

Abstract Aims Patients with systemic right ventricles are at high risk of sudden cardiac death. Arrhythmia is a significant risk factor. Routine Holter monitoring is opportunistic with poor adherence. The aim of this study was to determine if continuous rhythm monitoring with an implantable loop recorder (ILR) could allow early detection of clinically important arrhythmias. Methods and results Implantable loop recorder implantation was offered to patients with atrial switch repair for transposition of the great arteries. Recordings were made with symptoms or, automatically for pauses, significant bradycardia or tachycardia and reviewed by the multi-disciplinary team. Twenty-four out of 36 eligible patients underwent ILR implantation with no complication. Forty-two per cent had preserved ventricular function, 75% were NYHA functional class I, 88% had low sudden cardiac death risk, 33% had previous intra-atrial re-entrant tachycardia (IART), and none had known conduction disease. Eighteen out of 24 (75%) patients made 52 recordings (52% automated) over 39.5 months (1.6–72.5). Thirty-two out of 52 (62%) recordings in 15/24 (63%) of the cohort were clinically significant and included sinus node disease (two patients), atrioventricular block (two patients), IART (seven patients), and IART with sinus node disease or atrioventricular block (four patients). Implantable loop recorder recordings prompted medication change in 11 patients [beta-blockers (n = 9), anti-coagulation (n = 5), and stopping anti-coagulation (n = 1)] and device therapy recommendation in seven patients [five pacemakers (three: atrioventricular block) and two defibrillators]. Two patients declined intervention; one suffered an arrhythmic death. Intra-atrial re-entrant tachycardia and clinically relevant conduction disease were detected in patients irrespective of sudden cardiac death risk. Conclusion Continuous monitoring with an ILR in patients with systemic right ventricle following atrial switch detects clinically relevant arrhythmias that impact decision-making. In this cohort, clinically relevant arrhythmias did not correlate with sudden cardiac death risk.

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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