FIGURE 49-1 ILR recorded asystole.
EPIDEMIOLOGY
Syncope, defined as the transient loss of postural tone and consciousness and spontaneous recovery, is a common clinical problem.1 Approximately 3% of all emergency department visits and 1% to 6% of hospital admissions are for syncope. While a complete history and physical examination combined with direct laboratory testing can adequately establish a diagnosis in many patients, there are nonetheless patients who experience episodic cardiac arrhythmias that are not apparent on initial evaluation. They are often intermittent and transient and therefore difficult to detect. In these patients prolonged ambulatory monitoring using both external and now implantable electrodiagnostic recorders has been of great use in establishing a diagnosis. Indeed, by allowing for prolonged electrocardiographic monitoring, the implantable loop recorder (ILR) is able to provide a more certain correlation between observed rhythm experiences and the patient’s symptoms. While external monitoring is only practical for relatively short periods of time, the ILR is capable of monitoring for up to 3 years. In addition, the ILR has the ability to auto-activate when a rhythm disturbance is present, thereby allowing episodes to be recorded independent of the patient having to activate the device. There are two ILRS that are presently available in the United States.2
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