322 Implantable Loop Recorders in unexplained falls

Abstract Background Falls are the most common cause of injury in older adults leading to hospitalisation, functional decline, and increased morbidity and mortality. Cardiac arrhythmia is a known risk factor for falls with arrhythmias implicated as causative in up to 20% of unexplained falls in older adults. The aim was to examine arrhythmia and activity data in older fallers using an Implantable Loop Recorder (ILR) with an embedded accelerometer (Medtronic reveal LINQ). Methods Thirty participants with at least two falls in the previous two years were prospectively recruited. All met criteria for ILR insertion following a comprehensive cardiovascular assessment, where no abnormalities were detected. Cardiac and accelerometer data were collected for 1 year. Falls details were collected using falls diaries. Results The mean age of participants was 68.0 years (±9.3). 19/30 (63.3%) were female. 22/30 (73.3%) had at least one cardiovascular condition documented in their medical history. Sixteen participants (53%) had a significant arrhythmia during follow up with mean time to arrhythmia 101.6 days. Arrhythmias included tachyarrhythmias, bradyarrhythmia (with asystole) and atrial fibrillation. Five (17%) required pacemaker insertion. Combining nocturnal and diurnal cardiac parameters with accelerometer data were not predictive of falls. Conclusion ILRs are useful tools to help identify the cause of unexplained falls. The paroxysmal nature of arrhythmia make diagnosis without prolonged monitoring difficult, given that all participants had thorough cardiovascular investigations prior to implantation. This research supports European Society of Cardiology and World Falls guidelines for implantation of ILR in older people with unexplained falls. The addition of a triaxial accelerometer did not demonstrate added value in falls prediction.