Detection of arrhythmias in adult congenital heart disease patients with LINQTM implantable loop recorder. (16th July 2019) - Dodeja, Anudeep K.
Abstract: Background: Rhythm disorders are the leading cause of morbidity and mortality in adults with congenital heart disease (ACHD). Infrequent or asymptomatic arrhythmias may not be detected by routine monitoring. Implantable loop recorders (ILRs), such as the Reveal LINQ TM, have been useful in long‐term monitoring for arrhythmias in adults with cryptogenic stroke. Objective: We propose the Reveal LINQ TM will detect arrhythmias, not documented by other monitoring modalities, resulting in change in management in ACHD patients. Methods: This is a single center retrospective review of Reveal LINQ TM use in ACHD patients from 2014‐2017. Medical records were reviewed to determine cardiac diagnosis, indication for implant, ILR findings, and changes in management. Results: Twenty‐two patients, median age 25 years, underwent ILR implantation. ILR findings resulted in change in management in nine (41%) patients. One‐third (3/9) of the patients with clinically relevant events were asymptomatic. Patients with Fontan palliation had the highest number of pertinent positive events (57%). ACHD physiologic class D patients were more likely to have a positive finding ( P = .034) compared to other physiologic classes. Majority (75%) of patients with positive events had arrhythmias documented on ILR which were not demonstrated on prior Holter/event monitors. Pertinent negative event occurred in one patient with Fontan palliation (5%) who had syncope corresponding to sinus rhythm. Conclusion: ILRs are a useful adjunct for arrhythmia monitoring in the ACHD population with clinically relevant events in 41% of patients. A special consideration for ILRs could be made for high‐risk asymptomatic patients.