Implantable loop recorders in pediatric practice.

Symptoms of syncope and palpitations are not uncommon in children with and without heart disease. They present a diagnostic dilemma when conventional cardiovascular testing is inconclusive. The implantable loop recorder (ILR) has been shown to play an important role in diagnosing recurrent syncope in adult patients. In pediatric practice its role still has to be defined. The aim of this review is to assess the diagnostic yield of the ILR in children and young adults. Seven patients, 4 male and 3 female, were included in the study. Mean age at implantation was 12.8, range 0.8 to 25.9. Indications for ILR were syncope (N=6), near-syncope (N=1), palpitations (N=2) and acute life threatening event (N=2). Previous testing included 12-lead ECG (N=7), echo (N=7), 24 hour Holter (N=7), 4 week ambulatory Holter (N=3), exercise test (N=4) and invasive electrophysiologic study (N=3). Over a mean follow-up period of 7.5 months (range 3 to 16 months), 4 (57%) patients continued to have symptoms. The ILR enabled the correct diagnosis to be established in all, allowing for appropriate therapy.