Early versus delayed implantation of a loop recorder in patients with unexplained syncope — Effects on care pathway and diagnostic yield

Abstract Background This study looked to assess the care pathway and diagnostic yield in patients who received an implantable loop recorder (ILR) after an "initial phase of the diagnostic work-up" (initial work-up) or after a "full evaluation" of unexplained syncope. Methods and results Physicians classified the timing of an ILR implant in 514 patients as either following an "initial work-up" ( n =128; 25%) or "full evaluation" ( n =386; 75%). Patients with an "initial work-up" underwent a median (IQ range) of 8 (6–14) tests prior to ILR implant compared to 14 (10–21) tests after "full evaluation" ( p p p p Conclusions Patients who only underwent an "initial work-up" had fewer investigations and a lower incidence of injury or hospitalization. The diagnostic yield from the ILR was high in both groups. Patients in both groups underwent more investigations than suggested in the ESC guidelines and could have benefitted from limiting the initial evaluation before an ILR is implanted.