Background

Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited.

Objective

We evaluated the safety and efficacy of our nurse-led syncope clinic and nurse-led ILR implants.

Methods

A retrospective study of all consecutive patients undergoing nurse-led ILR implantations was performed between April 2016 and April 2018. Patients were referred from both nurse-led and physician-led clinics. Data were collected on baseline demographic characteristics, referral source, symptom-rhythm correlation, ILR findings, and subsequent changes to management. All ILRs were enrolled into remote monitoring with automatic arrhythmia detection, and all immediate (≤24 hours) ILR implant complications were recorded. Comparisons were made between nurse-led and physician-led clinics and subsequent outcomes.

Results

A total of 432 patients with an ILR were identified: 164 (38%) from nurse-led and 268 (62%) from physician-led clinics; 200 (46%) were women (mean age 66.5 ± 18.2 years; mean follow-up duration 28.9 ± 9.5 months). Primary ILR indications were syncope (n = 251 [58%]), presyncope (n = 33 [7%]), palpitation (n = 39 [9%]), cryptogenic stroke (n = 78 [18%]), and other reasons (n = 31 [7%]). No immediate ILR implant complications occurred. Overall, 156 patients (36%) had a change in management as a direct result of ILR findings, with no overall differences between nurse-led and physician-led clinics (35% vs 36%; P = .7). More patients had newly diagnosed atrial fibrillation in physician-led clinics (15% vs 7%; P = .01), and more patients had pacemaker implants for bradycardia in nurse-led clinics (23% vs 13%; P < .01).

Conclusion

Nurse-led ILR implantation was safe and effective. Nurse-led syncope clinics achieved good symptom-rhythm correlation with resultant significant changes to management in comparison to physician-led clinics. Larger prospective studies are needed to evaluate their longer-term impact.

中文翻译：

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护士主导的晕厥诊所和植入式循环记录器植入物的安全性和结果

背景

植入式循环记录器 (ILR) 可有效实现症状-节律相关性。ILR、护士主导的晕厥诊所和护士主导的 ILR 植入物的诊断率数据有限。

客观的

我们评估了护士主导的晕厥诊所和护士主导的 ILR 植入物的安全性和有效性。

方法

在 2016 年 4 月至 2018 年 4 月期间，对所有接受护士主导的 ILR 植入的连续患者进行了一项回顾性研究。患者来自护士主导和医生主导的诊所。收集了关于基线人口统计学特征、转诊来源、症状-节律相关性、ILR 发现和随后的管理变化的数据。所有 ILR 都被纳入具有自动心律失常检测的远程监测，并记录了所有即时（≤24 小时）ILR 植入并发症。对护士主导和医生主导的诊所以及随后的结果进行了比较。

结果

共确定了 432 名 ILR 患者：164 名（38%）来自护士主导的诊所，268 名（62%）来自医生主导的诊所；200 (46%) 名女性（平均年龄 66.5 ± 18.2 岁；平均随访时间 28.9 ± 9.5 个月）。主要 ILR 适应症是晕厥 (n = 251 [58%])、晕厥前兆 (n = 33 [7%])、心悸 (n = 39 [9%])、隐源性中风 (n = 78 [18%]) 和其他原因（n = 31 [7%]）。没有立即发生 ILR 植入并发症。总体而言，156 名患者 (36%) 因 ILR 发现而改变了管理方式，护士主导的诊所和医生主导的诊所之间没有总体差异 (35% vs 36%; P = .7)。更多患者在医生主导的诊所新诊断出心房颤动（15% vs 7%；P= .01），并且在护士主导的诊所中，更多的患者因心动过缓而植入起搏器（23% vs 13%；P < .01）。

结论

护士主导的 ILR 植入是安全有效的。与医师主导的诊所相比，护士主导的晕厥诊所实现了良好的症状-节律相关性，从而对管理产生了重大变化。需要更大规模的前瞻性研究来评估其长期影响。