Implantable loop recorders in patients with atrial fibrillation

ABSTRACT

Introduction

Implantable loop recorders (ILRs) provide practitioners with high-quality electrocardiographic data over an extended monitoring period. These data can guide the diagnosis and management of patients with atrial fibrillation (AF).

Areas Covered

This review summarizes the available evidence and consensus statements supporting the use of ILRs in the detection of AF, as well as monitoring of patients with known AF. Future directions for research are also discussed.

Expert Opinion

ILRs are the gold standard for detecting AF, providing superior diagnostic yield compared to other modes of ambulatory electrocardiography monitoring. Both experimental evidence and consensus statements support the use of ILRs in clinical settings where the diagnosis of AF may significantly change management, or where a high degree of sensitivity is needed. ILRs may also be used to monitor patients following AF ablation. More evidence is needed to better inform how ILR-detected AF should change management.

KEYWORDS:

• Implantable loop recorders
• ILR
• atrial fibrillation
• cryptogenic stroke
• ambulatory ECG

Article highlights

• Patient selection is paramount in maximizing the yield of ILRs in patients with or at risk of AF.

• ILRs outperform most other modalities of AF monitoring with respect to diagnostic yield and are the gold standard for AF detection.

• Transmitted episodes of device-detected AF require manual review by an expert to reduce false-positive rates.

• ILRs are highly likely to change management compared to other methods of ambulatory ECG monitoring, especially in elderly patients.

• The unclear relationship between device-detected AF burden and stroke risk suggests the need for further study to better inform ILR use in guiding oral anticoagulation.

Abbreviations

AF, atrial fibrillation; BMI, body mass index; ECG, electrocardiography; ESUS, embolic stroke of unknown source; HF, heart failure; ILR, implantable loop recorder; MRI, magnetic resonance imaging; OSA, obstructive sleep apnea; RCT, randomized control trial; RF, radiofrequency

Declaration of Interest

A Baranchuk has received unrestricted grants from Abbott, Medtronic, and Bayer, which were not related to the topic of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.