Optimal duration of loop recorder monitoring: brugada syndrome as the exception
L Cocchiara, B Brescia, P Marchese, S Nardi, G Brescia, S Nardi, A RapacciuoloAbstract
Background/Introduction
Implantable loop recorders (ILRs) are effective tools for arrhythmia diagnosis, yet the optimal follow-up duration remains uncertain. Defining when to discontinue monitoring across clinical indications is crucial to optimize healthcare resources.
Purpose
To assess the time to diagnosis and diagnostic yield of ILRs by clinical indication, identifying patients who may benefit from monitoring beyond 25 months.
Methods
This multicenter retrospective study included 1,500 patients who received an ILR for syncope, palpitations, cryptogenic stroke, or Brugada syndrome. Time to diagnosis, clinically relevant events by indication, and the number needed to follow (NNF) were analyzed. The 25-month optimal cut-off was determined using maximal rank statistics.
Results
Most diagnoses occurred within 25 months for syncope (NNF: 3.54 vs ∞), palpitations (4.26 vs 25.33), and stroke (5.88 vs 19.07), with a significant drop in yield beyond this period (all p<0.001). Conversely, in Brugada syndrome, the diagnostic rate remained stable after 25 months (NNF: 9.82 vs 10.01; p=0.815), with late detection of ventricular tachycardia and pauses.
Conclusions
ILR monitoring can be safely limited to 14–16 months in most indications without diagnostic loss. However, prolonged follow-up remains beneficial in Brugada syndrome. These findings support a personalized, indication-based approach to ILR monitoring duration, enhancing clinical efficiency and resource use.Graphical Abstract