Hello everyone, my name is Ermin Tala, OMS-IV from NYIT College of Osteopathic Medicine. Today I will be presenting on the utility of the implantable loop recorder in patients with Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder. Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder, EDS and HSC for short, are connective tissue disorders characterized by hyper-elastic skin and hyper-flexible joints. Patients may initially present with these clinical signs, but may also often present with cardiac complaints, including palpitations, presyncope, and orsyncope. These symptoms may be attributable to a comorbid condition known as Postural Orthostatic Tachycardia Syndrome. However, occasionally, the etiology of these symptoms is unclear and may require cardiac monitoring. The objective of this study was to evaluate the utility of the ILR in diagnosing and or excluding arrhythmias not attributed to POTS in symptomatic EDS and HSC patients. Between January 2019 to November 2023, patients were referred from the NYIT Ehlers-Danlos Syndrome Hypermobility Center for cardiac screening and evaluation. An implantable loop recorder was indicated in patients with a history of or actively experiencing recurrent presyncope or syncope of unknown etiology, as well as palpitations that did not appear positional in nature. The utility of the ILR was then evaluated based on at least one of the following criteria, a correlation of symptoms to an arrhythmia, the device's ability to monitor therapy efficacy, and or the device's ability to rule out an arrhythmia as the explanation of symptoms. In the course of the study, 116 hypermobile patients were evaluated. Of these 116 patients, 31 received an ILR. Of these 31 patients, 20 patients had a diagnosis of EDS, specifically with 23 having a diagnosis of hypermobile EDS, 3 with classic-like EDS, and 2 with vascular EDS. The remaining 3 patients had a diagnosis of HSD. Overall, symptomatic non-physiologic sinus tachycardia was the most common symptomatic arrhythmia and occurred in 16 patients. Figures 1 and 2 highlight and provide a summary of arrhythmia findings found on ILR remote transmissions in both EDS and HSD patients. In figure 1, looking specifically at the HSD patients, we see that supraventricular tachycardia, or SVT, was the most common symptomatic arrhythmia, followed by sinus tachycardia. Also of note, 1 patient with HSD and POTS had sinus tachycardia as their most common arrhythmia, and 2 patients who did not have the diagnosis of POTS had SVT as their most common arrhythmia. Figure 2, looking at the EDS patients, we see that sinus tachycardia was the most common symptomatic arrhythmia in this group, followed by supraventricular tachycardia, paroxysmal supraventricular tachycardia, and premature ventricular complexes, and then a combination of sinus tachycardia and supraventricular tachycardia, and then lastly ventricular tachycardia. Also of note, 16 patients with EDS had POTS and had symptomatic arrhythmia, as well as 12 patients who did not have a diagnosis of POTS having symptomatic arrhythmias. Overall, between groups, sinus tachycardia was still the most common symptomatic arrhythmia regardless of POTS diagnosis. As well, ILR findings helped in diagnosing POTS as well as in monitoring therapy in 15 patients. ILR findings also led to further interventions in 2 patients including PVC ablation and ICD implantation. ILR findings also led to the recommendation for pacemaker implantation in 1 patient. Overall, in this study, the ILR was useful in identifying symptomatic arrhythmias and solidifying POTS diagnosis as well as helping monitor treatment. ILR monitoring further guided patient management in helping in the prescription of lifesaving interventions including ablation, ICD implantation, and pacemaker recommendation. Limitations of this study include its retrospective design and its small sample size. Further evaluation of a larger cohort is needed to fully understand the impact of ILR monitoring as well as remote monitoring in general in the hypermobile, EDS, and HST group. Lastly, I would like to close by thanking the Long Island Heart Rhythm Center and NYT Com for their continuous support during this study. I'd also like to give a special thanks to Nurse Jill for her contributions in helping collect data as well as in ensuring patient follow-up. Thank you.

implantable loop recorders

Ehlers-Danlos Syndrome

Hypermobility Spectrum Disorder

arrhythmias

cardiac symptoms