Safety and outcome of nurse-led syncope clinics and implantable loop recorder implants

Published:November 09, 2021DOI:


      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.


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


      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.


      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).


      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.


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        • Brignole M.
        • Moya A.
        • de Lange F.
        • et al.
        2018 ESC Guidelines for the diagnosis and management of syncope.
        Eur Heart J. 2018; 39: 1883-1948
        • Padmanabhan D.
        • Kancharla K.
        • El-Harasis M.A.
        • et al.
        Diagnostic and therapeutic value of implantable loop recorder: a tertiary care center experience.
        Pacing Clin Electrophysiol. 2019; 42: 38-45
        • Lim W.Y.
        • Papageorgiou N.
        • Sukumar S.M.
        • et al.
        A nurse-led implantable loop recorder service is safe and cost effective.
        J Cardiovasc Electrophysiol. 2019; 30: 2900-2906
        • Escondo A.
        • Money J.
        • Boddington D.
        Nurse-led insertion of implantable loop recorders.
        Heart Lung Circ. 2018; 27: S37
        • Hamdan M.H.
        • Walsh K.E.
        • Brignole M.
        • Key J.
        Outreach syncope clinic managed by a nurse practitioner: outcome and cost effectiveness.
        J Telemed Telecare. 2018; 24: 566-571
        • Adlan A.M.
        • Eftekhari H.
        • Paul G.
        • Hayat S.
        • Osman F.
        The impact of a nurse-led syncope clinic: experience from a single UK tertiary center.
        J Arrhythm. 2020; 36: 854-862
        • Linker N.J.
        • Voulgaraki D.
        • Garutti C.
        • Rieger G.
        • Edvardsson N.
        Early versus delayed implantation of a loop recorder in patients with unexplained syncope—effects on care pathway and diagnostic yield.
        Int J Cardiol. 2013; 170: 146-151
        • Solomon M.D.
        • Yang J.
        • Sung S.H.
        • et al.
        Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring.
        BMC Cardiovasc Disord. 2016; 16: 35
        • Edvardsson N.
        • Wolff C.
        • Tsintzos S.
        • Rieger G.
        • Linker N.J.
        Costs of unstructured investigation of unexplained syncope: insights from a micro-costing analysis of the observational PICTURE registry.
        Europace. 2015; 17: 1141-1148
        • Boriani G.
        • Glotzer T.V.
        • Santini M.
        • et al.
        Device-detected atrial fibrillation and risk for stroke: an analysis of ˃10 000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices).
        Eur Heart J. 2014; 35: 508516