Abstract 53: Implantation of Loop Recorder In Patients with Ehlers-Danlos Syndrome

Background: Patients (pts) with Ehlers-Danlos Syndrome (EDS) have a higher incidence of syncope and have a higher rate of complications from incision related procedures. We serve a large population of pts with EDS and report our experience with pts with EDS who required Implantable loop recorder (ILR). Methods: We have conducted a retrospective study on a total of 94 pts with ILR implantation from 2014-2016. Out of 94 pts, there were 20 males (average age=50.8 + 20.143 yrs, 21.28%) and 74 females (average age= 47.59 + 17.296 yrs, 78.72%). Total of 24 (25.53%) pts with EDS who had ILR over the last 2 years. Pts were grouped into 3 categories (1) pts with EDS where ILR implantation was done with the standard technique (2) Our learning curve & (3) the results after the standardized new technique for ILR. 1. Category 1 pts, we used the standard provided by the manufacturer to create a V-shaped cut, loop recorder was inserted; subsequently Dermabond was applied. 2. Category 2 pts, we modified the technique, made a more horizontal incision with the V-shaped blade and a 4-0 Vicryl suture was used to improve wound healing. 3. Category 3 pts, after standardizing the technique, we used the V-shaped blade provided with 4-0 Vicryl knotless continuous suture to tamponade the bleeding. The Dermabond was applied only after local hemostasis was observed. Findings: When the loop recorder was implanted using the standard technique, more of bleeding, bigger scars and multiple keloid formation was observed. In the category 1, we learned that if proper hemostasis is not obtained during the implantation, the patient tended to have more scars. In category 3, when 1-2 layers of Vicryl sutures were applied, the first layer of sutures were subcutaneous & the second was under the skin and a knot less closure was done, hemostasis was obtained prior to applying Dermabond, patients did not have scar formation. Conclusions: We hereby conclude that EDS pts who required ILR, the wound should be closed with 1-2 layers of Vicryl using a knot-less closure technique which will leave a more aesthetically acceptable scar. We would also recommend that until further research is done, this same technique should be use in patients with other hereditary connective tissue disorders.