ΤΑ ILRS ΣΤΗΝ ΚΛΙΝΙΚΗ ΠΡΑΞΗ

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1 ΤΑ ILRS ΣΤΗΝ ΚΛΙΝΙΚΗ ΠΡΑΞΗ ΠΑΝΑΓΙΩΤΗΣ ΚΟΡΑΝΤΖΟΠΟΥΛΟΣ Ε ίκουρος Καθηγητής Καρδιολογίας Α Καρδιολογική Κλινική Πανε ιστημίου Ιωαννίνων

Secondary 3 Bradycardia Sinus pause/arrest AV block Tachycardia VT SVT LongQT Synd ΑΝΕΞHΓΗΤΑ

2 ΣΥΓΚΟΠΗ - ΑΙΤΙΟΛΟΓΙΑ ΝΕΥΡΟΚΑΡΔΙΟΓΕΝΗΣ ΑΝΤΑΝΑΚΛΑΣΤΙΚΗ ΟΡΘΟΣΤΑΤΙΚΗ ΚΑΡΔΙΑΚΕΣ ΑΡΡΥΘΜΙΕΣ Δομικά Καρδιοπνευμονικά 1 VVS CSS Situational Cough Postmicturition 2 Drug-Induced ANS Failure Primary Secondary 3 Bradycardia Sinus pause/arrest AV block Tachycardia VT SVT LongQT Synd ΑΝΕΞHΓΗΤΑ ΑΙΤΙΑ = Περίπου 10-20% 4 Aortic Stenosis HCM Pulmonary Embolism Aortic Dissection 40-50% 10-15% 10-20% 5%

4 ΔΙΑΓΝΩΣΤΙΚΗ ΠΡΟΣΕΓΓΙΣΗ ΣΥΓΚΟΠΗΣ

6 Implantable loop recorder in the work-up of transient loss of consciousness (T-LOC). Task Force members et al. Europace 2009;11:

7 EHRA POSITION PAPER ON ILRS Brignole M, Vardas P, Hoffman E, et al. Indications for the use of diagnostic implantable and external ECG loop recorders. Europace 2009;11:

2 Days Typical Event Recorder 7 Days MCOT External Loop Recorder 30+ Days

8 Heart Rhythm Monitoring Options Syncope Occurs Infrequently, Long-term Monitoring is Likely to be Most Effective 12-Lead 10 Seconds Holter Monitor 2 Days Typical Event Recorder 7 Days MCOT External Loop Recorder 30+ Days ILR 36 Months ILR = insertable loop recorder MCOT= mobile cardiac outpatient telemetry

9 ILRS THE EVOLUTION..

10 Syncope Diagnostic Assessment: Yields Yield (%) Initial Evaluation History, Physical Exam, ECG, Cardiac Massage Other Tests/Procedures Head-Up Tilt 27 External Cardiac Monitoring 5-13 Insertable Loop Recorder (ILR) EP Study <2-5 Exercise Test 0.5 EEG MRI No data available 6 References Available

11 PICTURE REGISTRY

12 1/4 1/2

13 UNEXPECTED DOESN T NEED TO BE UNEXPLAINED All episode details at your fingertips After experiencing symptoms, the patient activated Reveal memory storage. Almost simultaneously, an asystole was automatically recorded by Reveal. Event markers show what Reveal captured.

14 SYMPTOM-RHYTHM CORRELATION

15 Mechanism of syncope in patients with unexplained syncope and ILR inserted at the end of the conventional work-up (pooled data of 509 patients from nine studies) Brignole, M. et al. ESC Textbook of Cardiovascular Medicine /med/ Copyright restrictions may apply.

17 SECONDARY PREVENTION IN ATHEROTHROMBOTIC STROKE

18 YIELD OF OUTPATIENT ELECTROCARDIOGRAPHIC MONITORING FOR AF IN CRYPTOGENIC STROKE

19 Value of Advanced Diagnostics What is the AF burden? How long do the episodes last? When did the episodes start? Note: All clinic, physician, and patient names and data in this document are fictitious

22 Detection of atrial fibrillation in stroke survivors AF / ESC GUIDELINES 2016

23 UNIVERSITY OF IOANNINA MEDICAL SCHOOL, FIRST DEPARTMENT OF CARDIOLOGY from April 2012 to December Mean F/U 22 months.

24 Contemporary diagnostic yield of implantable loop recorders in patients from Northwestern Greece Panagiotis Korantzopoulos, Ioannis Ntalas, Aris Bechlioulis, Dimitrios Nikas, John A. Goudevenos

25 Contemporary diagnostic yield of implantable loop recorders in patients from Northwestern Greece Panagiotis Korantzopoulos, Ioannis Ntalas, Aris Bechlioulis, Dimitrios Nikas, John A. Goudevenos

CASE REPORT Advanced atrioventricular block with a very prolonged ventricular asystole

Korantzopoulos 1, Ioannis V. Ntalas 1, Michail I. Papafaklis 2 & John A.

disease underwent an implantable loop recorder implantation for recurrent syncopal

Four hours after implantation the patient suffered sudden loss of consciousness while

26 CASE REPORT Advanced atrioventricular block with a very prolonged ventricular asystole detected four hours after placement of an impantable loop recorder P. Korantzopoulos 1, Ioannis V. Ntalas 1, Michail I. Papafaklis 2 & John A. Goudevenos 1 In this report we present a 42-year-old woman without structural heart disease underwent an implantable loop recorder implantation for recurrent syncopal episodes during the past 12 years. Four hours after implantation the patient suffered sudden loss of consciousness while sitting on her bed in the ward. Interestingly, interrogation of the device revealed an episode of advanced atrioventricular block with a very prolonged ventricular asystole of 25 seconds.

27 AN ILR FALSELY INSERTED..

28 ΚΑΝΕΝΑ ILR ΔΕΝ ΕΜΦΥΤΕΥΘΗΚΕ ΣΤΑ ΠΛΑΙΣΙΑ ΚΡΥΠΤΟΓΕΝΟΥΣ ΑΕΕ..

29 ΣΥΜΠΕΡΑΣΜΑΤΙΚΑ - ILRS ΣΤΗΝ ΚΛΙΝΙΚΗ ΠΡΑΞΗ

30 ΕΥΧΑΡΙΣΤΏ ΠΟΛΥ ΓΙΑ ΤΗΝ ΠΡΟΣΟΧΗ ΣΑΣ.

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