Medtronic
 
 

Insertable Loop Recorder

Guidelines for use of Reveal® Plus

ACC/AHA Guidelines for Ambulatory Electrocardiography (AECG)

Indications for AECG to Assess Symptoms Possibly Related to Rhythm Disturbances

Class I:

Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective.

1. Patients with unexplained syncope, near syncope, or episodic dizziness in whom the cause is not obvious.

2. Patients with unexplained recurrent palpitation.

“Newer loop recorders can be implanted under the skin for long-term recordings, which may be particularly useful for patients with infrequent symptoms.”1,2

Class II:

Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Class IIb: Usefulness/efficacy is less well-established by evidence/opinion.

1. Patients with episodic shortness of breath, chest pain, or fatigue that is not otherwise explained.

2. Patients with neurological events when transient atrial fibrillation or flutter is suspected.

3. Patients with symptoms such as syncope, near syncope, episodic dizziness, or palpitation in whom a probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause.

* In the management of syncope the ESC Guidelines recommend the use of an Insertable Loop Recorder at these points in the flow diagram..(Guidelines on Management (Diagnosis and Treatment) of Syncope. The Task Force on Syncope, European Society of Cardiology. Europace 2004;6:467-537)

To access more detail on ACC/AHA Guidelines click here.

European Society of Cardiology (ESC)
Guidelines for the Management of Syncope

Indications for Electrocardiographic Monitoring

Class I:

  • In-hospital monitoring (in bed or telemetric) is warranted when the patient has an important structural heart disease and is at high risk of life-threatening arrhythmias (see chapter ‘Need for Hospitalization’)

  • Holter monitoring is indicated in patients who have the clinical or ECG features suggesting an arrhythmic syncope and very frequent syncopes or pre-syncopes

  • When the mechanism of syncope remains unclear after full evaluation, Implantable Loop Recorder is indicated in patients who have the clinical or ECG features suggesting an arrhythmic syncope or a history of recurrent syncope with injury

Class II:

  • Holter monitoring may be useful in patients who have the clinical or ECG features suggesting an arrhythmic syncope in order to guide subsequent examinations (i.e., electrophysiological study)

  • External Loop Recorder may be indicated in patients who have the clinical or ECG features suggesting an arrhythmic syncope and inter-symptom interval 64 weeks

  • Implantable Loop Recorder may be indicated:

    • In an initial phase of the workup instead of completion of conventional investigations in patients with preserved cardiac function who have the clinical or ECG features suggesting an arrhythmic syncope

    • To assess the contribution of bradycardia before embarking on cardiac pacing in patients with suspected or certain neurally mediated syncope presenting with frequent or traumatic syncopal episodes

To access more detail on ESC Syncope Management Guidelines, click here.

Additional Information