47 Investigating implantable loop recorder settings for the detection of non-sustained ventricular arrhythmias in an inherited cardiac conditions population

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Introduction The European Society of Cardiology (ESC) defines non-sustained ventricular tachycardia (NSVT) as a wide complex tachycardia of ventricular origin with ≥3 beats, rate >100 bpm, lasting <30 seconds, and not causing haemodynamic compromise. The implantable loop recorder (ILR) is a subcutaneous device that monitors cardiac rhythm over an extended period, capable of automatic and manual rhythm recordings. This study examines a population at risk of inherited cardiac conditions (ICC) attending a specialist clinic with ILRs inserted per ESC guidelines. Purpose This study investigates the utility of increasing ILR sensitivity for detecting ventricular arrhythmias by assessing if lowering the automatic detection threshold from ≥16 sensed beats to ≥5 sensed beats leads to more appropriate interventions. Methods This retrospective study included all 257 patients with an ILR followed by an ICC clinic over a median of 2.4 years. 71% of patients had tachycardia detection settings adjusted from the nominal ≥16 beats to ≥5 beats. Potentially significant ILR recordings were analysed by clinic physiologists and cardiologists. Patient clinic letters were reviewed to determine if NSVT detection led to a change in management. Results The study population included 43 patients (16.7%) with structural heart disease (SHD). NSVT was recorded in 36 patients (14%); 25 (69%) had NSVT of 5–15 beats, detectable only with increased sensitivity, while 11 (31%) had NSVT detectable by the original ≥16 beats setting (figure 1). Considering changes in management, 8 patients (22%) had SHD with a subsequent change in management; 2 (6%) had SHD without a change; 7 (19%) without SHD had a change; and 19 (53%) without SHD had no change (figure 2). Conclusions NSVT was relatively rare despite long follow-up. Patients with SHD were almost 3 times more likely to experience NSVT and receive interventions (RR 2.97, 95% CI 1.47–6.02; p = 0.004), including implantable cardioverter defibrillators. Increasing ILR sensitivity benefits SHD patients, but further studies are needed.

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