A 60 y.o male with altered mental staus is found wandering; you notice something in his chest.

what happened to him?

Our patient had an implantable loop recorder that eroded through the skin. The device is covered by Medicare and can stay implanted for three years. The European College of Cardiology recommends implantation in the early stages of a syncope evaluation so they may be seen more frequently in the ED.

placement of a loop event monitor

Kaoru Tanno’s article reviews the studies which have been done comparing implantable loop event monitors with conventional syncope evaluations which include 2-4 weeks of external heart monitoring, electrophysiological studies and tilt table testing. The implantable monitor was more successful in making a diagnosis than conventional testing. There have been no studies showing that making the diagnosis improves quality of life or length of life.

The complications of the implantable loop event monitor include infection of the pocket and misdiagnosis since it has difficulty distinguishing at times between VT and SVT. The complications occur in 1-5% of patients.

Our patient had his event monitor removed in the ED.

Krahn A, Klein G. et al. The high cost of syncope: cost implications of a new insertable loop recorder in the investigation of recurrent syncope. Am Heart 1999. may, 137(5)870-87

Tanno K. Use of implantable and external loop recorders in syncope with unknown causes. Arrhythm 2017 v33(6) . This reference includes the RAST study comparing external recording x 2-4 wks, with EP testing and tilt table vs 1 yr of an implantable recorder.

Onuki T, Ito H. Ochi A. Single center experience in Japanese patients with syncope. J Cardio 2015;66:395-402.

Ruwald M, Zereba W. ECG monitoring in Syncope. Prog Cardiovas Dis. 2013. 56:203-210.