PhD defence A. (Amira) Assaf

Below is a brief summary of the dissertation: 

The implantable loop recorder (ILR) has proven to be an effective tool for identifying the causes of unexplained loss of consciousness. This thesis investigates whether the ILR may also hold value beyond this specific indication in various patient groups.
For example, the ILR has been shown to be beneficial for patients with cardiomyopathies or primary electrical heart diseases, such as hypertrophic cardiomyopathy and Brugada syndrome. While these patients are at increased risk of sudden cardiac death, not all qualify for an implantable cardioverter-defibrillator (ICD). Research indicates that the ILR can detect early arrhythmias, influence clinical management, and provide reassurance to patients. However, its impact on long-term prognosis remains unclear.
In patients with chronic total coronary occlusion (CTO)—a prolonged blockage of a coronary artery—ILR monitoring has revealed an elevated risk of ventricular arrhythmias, even in those with normal left ventricular function. This increased risk appears to be associated with more extensive scar tissue in the heart muscle and the presence of hibernating myocardium in patients with a CTO. While revascularization might reduce this risk, studies show that even revascularized patients continue to face significant risks.
Additionally, the ILR has been evaluated for its role in monitoring atrial fibrillation (AF) in patients who have undergone AF ablation. The AF detection algorithm of the Biotronik III ILR has proven to be reliable and closely correlates with Holter monitoring, making the ILR a valuable tool for the follow-up of these patients.
The findings demonstrate that the ILR has broader applications beyond investigating unexplained loss of consciousness. It can play a key role in optimizing treatment strategies across various patient groups. However, further studies are necessary to better understand the ILR’s full impact on prognosis and treatment outcomes.