Open Access

ARTICLE

Detection of arrhythmias in adult congenital heart disease patients with LINQ^TM implantable loop recorder

Anudeep K. Dodeja¹, Courtney Thomas¹, Curt J. Daniels^1,2, Naomi Kertesz^1,2, Anna Kamp^1,2

1 Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
2 Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio

* Corresponding Author: Anudeep K. Dodeja, MD, Department of Pediatrics, Division of Cardiovascular Medicine, Columbus, OH. Email: Anudeep.Dodeja@ nationwidechildrens.org

Congenital Heart Disease 2019, 14(5), 745-751. https://doi.org/10.1111/chd.12815

Abstract

Background: Rhythm disorders are the leading cause of morbidity and mortality in adults with congenital heart disease (ACHD). Infrequent or asymptomatic arrhyth‐ mias may not be detected by routine monitoring. Implantable loop recorders (ILRs), such as the Reveal LINQ^TM, have been useful in long‐term monitoring for arrhythmias in adults with cryptogenic stroke.
Objective: We propose the Reveal LINQ^TM will detect arrhythmias, not documented by other monitoring modalities, resulting in change in management in ACHD patients.
Methods: This is a single center retrospective review of Reveal LINQ^TM use in ACHD patients from 2014‐2017. Medical records were reviewed to determine cardiac diag‐ nosis, indication for implant, ILR findings, and changes in management.
Results: Twenty‐two patients, median age 25 years, underwent ILR implantation. ILR findings resulted in change in management in nine (41%) patients. One‐third (3/9) of the patients with clinically relevant events were asymptomatic. Patients with Fontan palliation had the highest number of pertinent positive events (57%). ACHD physi‐ ologic class D patients were more likely to have a positive finding (P = .034) compared to other physiologic classes. Majority (75%) of patients with positive events had ar‐ rhythmias documented on ILR which were not demonstrated on prior Holter/event monitors. Pertinent negative event occurred in one patient with Fontan palliation (5%) who had syncope corresponding to sinus rhythm.
Conclusion: ILRs are a useful adjunct for arrhythmia monitoring in the ACHD popula‐ tion with clinically relevant events in 41% of patients. A special consideration for ILRs could be made for high‐risk asymptomatic patients.

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