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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.

Background The PULSE (PostUraL tachycardia Syndrome Exercise) study is a randomised controlled trial assessing the feasibility of conducting a multicentre RCT testing supervised exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with Postural Tachycardia Syndrome (PoTS). The original trial protocol was published in BMC Pilot & Feasibility Studies (accessible at 10.1186/s40814-020-00702-1). The PULSE intervention consists of (1) individual assessment; (2) 12-week, twice-weekly, supervised exercise training; (3) behavioural and motivational support; and (4) guided lifestyle physical activity. The control intervention is best-practice usual care with a single 30-min, one-to-one practitioner appointment, and general advice on safe and effective physical activity. Sixty-two people (aged 18–60 years) with a confirmed diagnosis of PoTS will be invited to enrol on a feasibility RCT with an embedded qualitative study. The primary outcome will be feasibility; process-related measures will include eligibility, recruitment, randomisation and withdrawal rates, along with indicators of exercise programme adherence and acceptability. Secondary physiological, clinical and health-related outcomes will be assessed. In response to the COVID-19 pandemic, here we describe amendments to the trial protocol. Methods Restrictions imposed by the COVID-19 pandemic meant it was necessary to change the delivery of the PULSE and control interventions. These changes reflected the need to limit the risk of COVID-19 transmission in a clinical population, some of whom were at increased risk of contracting the virus and suffering serious illness. The major change was that the originally intended centre-based PULSE and control interventions would now be delivered remotely on-line. Subsequently, there were minor changes to the participant eligibility criteria. These decisions followed an on-line co-creation session with people affected by PoTS, and relevant public and professional stakeholders. Conclusions We present an update of the original trial protocol in response to the COVID-19 pandemic. No participants were recruited to the original protocol; thus, results will reflect the on-line delivery of the intervention. PULSE will be the first randomised trial to assess the feasibility of conducting a definitive multi-centre RCT testing supervised on-line exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with PoTS. Trial registration ISRCTN45323485 registered on 7 April 2020.

Background and aims Syncope guidelines recommend Implantable loop recorders (ILR) to aid symptom-rhythm correlation. Arrhythmia Nurse Specialists (ANS) are important in assessment of these patients. Their effectiveness at risk stratification is unknown. ESC 2018 Syncope guidelines recommend more research. Our aim was to evaluate the diagnostic yield of all consecutive ILR implants over a 2-year period and compare ILR-guided management changes between ANS and clinicians. Methods Retrospective study of consecutive patients undergoing ILR implant between April 2016-April 2018, including baseline patient demographics, referral source and management changes made by ILR findings. Results 305 ILR patients were identified: median age 71 yrs (interquartile range 52–81), 45% female, median follow-up time 15months. Referrals were from general cardiology (GC)=98 (32%), electrophysiology (EP)=105 (34%) and ANS-led syncope clinic=102 (34%). Indications were syncope=203 (65.9%), palpitation=21 (6.9%), pre-syncope=16 (5.2%), cryptogenic stroke=35 (11.5%) and other reasons 7 (8.9%) (falls, channelopathies). Overall, 102 (34.0%) experienced arrhythmias detected on ILR that resulted in a change of management including: pacemaker implant=49 (16.1%), complex-device implant=7 (2.3%) and AF=28 (9.2%), SVT=14 (4.6%), VT=1 (0.3%). ANS referrals resulted in greater trend towards change of management (38.2%) of patients compared with GC (32.7%) and EP (31.4%) (p=0.593 nurse vs. consultant). For those needing pacing, 24 were from ANS referrals compared to 25 for clinicians (23.5% vs 18.3% respectively, p=0.012). Median time to developing a pacing indication was 2.6 months for ANS and 4.1 months for clinicians; 25 had pacing indication within 3 months of ILR insertion. Overall, an ILR had a diagnostic yield of 34.1% (n= 104) (table 1). Conclusion The diagnostic yield of ILR insertion was 34%. ANS referrals trended towards greater diagnostic yield compared with clinicians and significantly more pacemaker indications. Our data suggest ANS patient selection for ILRs are at least comparable to clinicians. Conflict of Interest None