“Closing the loop” on palpitations. A report of unexpected communication between a loop recorder symptom marker and pacemaker

Introduction Some patients continue to experience palpitations, near syncope, and syncope after pacemaker or implantable cardioverter-defibrillator (ICD) implantation. In these patients it is very useful to correlate symptomswith arrhythmias and to confirm that their implanted device is working appropriately and is programmed optimally. External event monitoring can be a helpful adjunct in this evaluation but is inconvenient and not tolerated well by many patients. A valuable alternative for patients who already have a specific Medtronic pacemaker or ICD may be the use of a Medtronic patient activator to mark symptomatic events for direct, convenient correlation of symptoms and rhythms.