27 Influence of routine cardiac rhythm assessment in the long-term management of channelopathy patients

Abstract

27 Table 1Rhythm disturbances identified in follow up of channelopathy patients Diagnosis Gene testing result Monitoring method Symptoms Rhythm disturbance Alteration to treatment 1 OOHCA Query LQTS Gene negative ICD yes syncope NCT/inappropriate shock BBlocker changed to verapamil 2 OOHCA Query BrS Gene negative ICD none NCT Medication change 3 LQTS KCNQ1 ILR yes palpitations & pre-syncope AF anticoagulation 4 Screening LQTS No gene testing ILR yes palpitations, pre-syncope & syncope SVT EPS/ablation 5 LQTS KCNQ1 Holter none 22% VEs, 7 beats NSVT ICD offered 6 LQTS KCNQ1 Holter yes palpitations PAT BBlocker commenced 7 BrS SCN5a VUS Holter yes palpitations Atrial PACs, NCT, conduction disease, NSVT ICD offered and declined *OOHCA: Out of hospital cardiac arrest, LQTS= LQT syndrome, BrS: Brugada syndrome, BBlocker: beta-blocker, NCT: narrow complex tachycardia, AF: atrial fibrillation, SVT: supraventricular tachycardia, NSVT: non-sustained ventricular tachycardia, PAT: paroxysmal atrial tachycardia, PACs: paroxysmal atrial complex, VE: ventricular ectopic, ILR: implantable loop recorder, ICD: Implantable cardiac defibrillator, EPS: EP study.ConclusionIn our selected channelopathy patients, we demonstrated that the yield of routine monitoring arrangement is low at 10% despite 50% of patients reporting concerning cardiac symptoms. A large proportion of our cohort continue to await rhythm assessment due to delays in scheduling from the Covid-19 pandemic but 93% have had no change in management to date. As of March 2021 mortality was only 1% with just a single patient dying of a suspected dysrhythmia. There is a lack of international guideline on timing of follow up investigation in routine management of channelopathies, but our cohort suggests that routine Holter monitoring in asymptomatic LQTS and BrS does not significantly alter sudden cardiac de th (SCD) risk management. We educate our ICC channelopathy patients’ to report their symptoms to facilitate prompt rhythm assessment, and given pressures on current health systems, perhaps focusing on these symptomatic patients would be an appropriate use of resources.