External loop recorders: determinants of diagnostic yield in patients with syncope

Objectives The purpose of the current study was to determine the optimal duration of external loop recorder (ELR) monitoring in patients with presyncope or syncope and to identify factors that predict failure to activate the device effectively. Design A multivariate analysis was performed using data from the Comparison Of Loop Recorders Against Holter in Patients with Syncope (COLAPS) trial, a prospective study comparing diagnostic utility of ELRs and Holter monitors for assessment of syncope. Methods Patients with failure to effectively activate ELRs were compared to those who were successful. This analysis was performed separately for failure of test transmission and for failure to successfully record and transmit data from symptomatic episodes. Patient characteristics were compared among the groups to determine risk factors for device failure. Results Among 78 patients who received ELRs, a test transmission was successfully performed by 84.5% of patients. Twenty-one percent of diagnoses were made within 48 hours, 50% at 15 days, and 90% at 33 days. Patients performing a successful test transmission were more familiar with technology, with ability to use a bank automatic teller machine being a significant independent predictor. Patients with a successful test transmission were, in turn, significantly more likely to record and transmit data from symptomatic episodes. Patients living alone were much less likely to use the loop recorder effectively. The presence of factors that may influence motivation to reach a diagnosis (degree of worry/fear of symptoms and impact on daily life) were associated with successful use of the device in a univariate analysis. Conclusion ELRs should be worn for at least 30 days to maximize their diagnostic yield. Patients who are unfamiliar with technology, live alone, or have low motivation to reach a diagnosis have a lower diagnostic yield from ELRs for assessment of syncope.