Syncope is a state of abrupt brief loss of consciousness caused by insufficient supply of the blood to the brain. Cardiac syncope represents 10% of all syncope cases. The mortality of patients with this kind of syncope is 20% - 30% every year. The cause of Cardiac syncope is a critical decrease in stroke volume of the heart, which might be because of mechanical obstruction or heart rhythm disorders.
Implantable Loop Recorder (ILR) is a technique in cardiology for the diagnosis of unexplained syncope, which has recently become more acceptable across the world.
What is an Implantable Loop Recorder?
An Implantable Loop Recorder (ILR) is a small and thin device that is implanted under the skin to record the constant activity of your heart. The ILR screens and records the electrical activity of the heart so as to recognize any changes to the rhythm of the heart. You might be encountering side effects that show you have an unusual heart rhythm such as palpitations, dizziness, or blackouts/fainting episodes (loss of awareness).
The ILR can be set up for as long as three years. In any case, the device might be taken out sooner depending upon the symptoms you experience, such as a fainting spell. Any episode can be recorded and captured. This can be easily done by placing a hand-held activator over the ILR and then press a button altogether for the device to save the information. This ought to be done while encountering symptoms. Whenever required, a relative or companion can put the activator over the device to save the data. It is critical to carry the activator with you so that any episode can be recorded. The recording will at that point be stored for your cardiovascular physiologist to examine to decide if an abnormal heart rhythm caused the symptoms.
Clinical Applications of Implantable Loop Recorders
1. Transient Loss of Consciousness and Recurrent Falls
Transient loss of consciousness can be defined as a condition of loss of awareness that is characterized by amnesia for the period of abnormal motor control, loss of responsiveness, etc. In such conditions, we may consider an early ILR implant as it has been successful in demonstrating to have high performances of diagnostic and to decrease the quantity and timing for further diagnostic investigations. It is always crucial to do a thorough and careful clinical evaluation of the characteristics of the patients. However, ILR has been proved to provide an additional value of diagnosis in patients with a real or apparent transient loss of consciousness.
In the condition of recurrent episodes, ILR is promising to both for the patient who doesn’t require extensive and various investigations and for the doctors for whom diagnosis may be made easier.
2. Unexplained Syncope
Among Transient loss of consciousness, the most widespread clinical application of ILR was in patients with recurrent syncope for whom the underlying assessment (clinical history, physical assessment, Holter ECG, echocardiogram) didn't prompt a diagnosis. Syncope is a clinical disorder portrayed by transient loss of consciousness and postural tone, which is often caused by brief cerebral hypoperfusion.
In spite of the fact that much of the cases the prognosis is benign, in a subgroup of patients with a secondary type of syncope and heart-related diseases, mortality can reach up to 30% per year. The assessment of patients with recurrent syncope requires an early and multi-disciplinary methodology so as to distinguish the exact cause and set up the best treatment. The regular clinical follow up for patients with unexplained syncope incorporates the monitoring with outer loop recorder, tilt testing, and electrophysiological study (EPS).
3. Patients with palpitations
Palpitations are normal and they are one of the most frequent symptoms answered to the doctor. An underlying clinical assessment gives a definitive or likely diagnosis of the reason for palpitations in about half of the patients and excludes with sensible assurance the presence of causes with a severe prognosis. However, much of the time, the administration of these patients is troublesome, ineffective, and strenuous. High-risk patients may require intervention to an aggressive degree, including hospitalization and invasive tests to eliminate the possibility of lethal arrhythmias. In these cases, the ILR can't be demonstrated.
Then again, patients with low-risks having frequent symptoms are the best ILR applicants. At the point when the nature of palpitations remains unexplained, a relationship between symptoms and ECG discoveries can be found utilizing continuous heart rhythm monitoring
Contrasted with standard traditional techniques, an implantable loop recorder is a significant tool in cardiology for diagnosing unexplained syncope as it permits extended monitoring and building up the correlations between symptoms and the time of heart rate which is recorded. The ILR has become a safe and successful method of monitoring patients experiencing repetitive unexplained syncope. Moreover, it shows a guarantee in monitoring atrial fibrillation and recognizing the etiology of palpitations.