EILR Electronic Implantable Loop Recorder

A new diagnostic and treatment strategy provided an 80% reduction in the one-year recurrence rate and a 92% reduction of total burden of syncope in some forms of neurally-mediated syncope.

This strategy consisted of risk stratification based on simple initial evaluation, early application of an implantable electrocardiographic monitor (Electro Implantable Loop Recorder - EILR), assessment of the exact mechanism of syncope by documenting a spontaneous episode and then prescribing mechanism-based specific therapy.

The previous strategy, in the absence of an electrocardiographic documentation of syncope, was principally guided by the results of tilt testing. Controlled trials of tilt-guided therapy, however, have often failed to show a benefit. In particular, the efficacy of pacemaker therapy was questioned after two recent controlled trials failed to prove superiority of cardiac pacing over placebo. This new research demonstrates that improved patient selection methods lead to significantly better therapy outcomes.

The International Study on Syncope of Uncertain Etiology 2 (ISSUE 2) was a multi-centre, prospective, observational study enrolling 442 patients from centres across Europe and in the US with a diagnosis of suspected neurally-mediated syncope (diagnosis made according to the criteria set by the Guidelines on Syncope of the European Society of Cardiology).

The ILR was placed subcutaneously under local anesthesia (Figure). High fidelity electrocardiographic recordings were captured through patient activation of the device or automatic activation using predefined arrhythmia triggers. The ILR carries an up-front cost of approximately �1.500. Previous studies showed that, when symptom-ECG correlation can be achieved in a substantial number of patients, analysis of the cost per symptom-ECG of the implanted device is more cost-effective than conventional diagnostic methods.

Four hundred and forty two patients with ?3 clinically severe syncopal episodes over two years with normal electrocardiograms and without significant electrocardiographic and cardiac abnormalities were included in the study. Patients with orthostatic hypotension and carotid sinus syncope were excluded. After ILR implantation, patients were followed until the first documented syncopal episode (Phase I). The mechanism of this episode was documented by ILR in 103 patients (mean time of 12�8 months) and guided subsequent therapy. Forty seven patients received a pacemaker because of asystole of a median 11.5 s duration, six patients had anti-tachyarrhythmia therapy (catheter ablation #4, implantable defibrillator #1, antiarrhythmic drug #1); the remaining 50 patients did not receive specific therapy. Following therapy, patients entered an observational period to determine syncope recurrence (Phase II). The table below summarizes recurrence results obtained in the two groups of patients.

The actuarial one-year recurrence rate in the subgroup of 47 patients who received pacemaker therapy was 5% (burden 0.05�0.15 episodes per patient/year), significantly lower than that observed in patients without asystole or bradycardia and of that observed in patients with asystole or bradycardia who did not receive a pacemaker.

The strategy was safe. Severe trauma secondary to syncopal relapse occurred in 2% and mild trauma in 4% of the patients. No patient died for syncope-related causes. In conclusion, this is the first study to demonstrate that a new strategy based on early application of ILR and therapy delayed after documentation of syncope allows a safe

Eil Resource

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E-Independent Local Radio

Independent Local Radio is the collective name given to commercial radio stations in the United Kingdom. The same name is used for Independent Local Radio in Ireland.
Contents

History

Development of ILR

Until the early 1970s, the BBC had a legal monopoly on radio broadcasting in the UK. Despite competition from the commercial Radio Luxembourg and, for a period in the mid-1960s, the off-shore "pirate" broadcasters, it had remained the policy of both major political parties that radio was to remain under the BBC.

Upon the surprise election of Edward Heath's government in 1970, this policy changed. Ironically, it is possible that Heath's victory was partly due to younger voters upset by the UK government closing down the popular pirate radio stations .

The new Minister of Post and Telecommunications, Christopher Chataway, announced a Bill to allow for the introduction of commercial radio in the United Kingdom. This service would be planned and regulated in a similar manner to the existing ITV service and would compete with the recently developed BBC Local Radio services (rather than the four national BBC services).

The Sound Broadcasting Act received Royal Assent on 12 July 1972 and the Independent Television Authority (ITA) accordingly changed its name to the Independent Broadcasting Authority (IBA).

The IBA immediately began to plan the new service, placing advertisements encouraging interested groups to apply for medium-term contracts to provide programmes in given areas. The first major areas to be advertised were London and Glasgow, with two contracts available in London, one for "news and information", one for "general and entertainment".

The London news contract was awarded to London Broadcasting Company (LBC) and they began broadcasting on 8 October 1973. The London general contract went to Capital Radio, who began broadcasting on 16 October 1973. In total, 19 contracts were awarded between 1973 and 1976. Due to government limits on capital expenditure and turbulence in the broadcasting field (mainly due to the Annan Report), no further contracts were awarded until 1980, when a second tranche of contracts were awarded. All stations were awarded an AM and an FM frequency, on which they broadcast the same service.

First and second tranche contracts
Airdate Town Station name
8 October 1973 London (news and information) LBC
16 October 1973 London (general and entertainment) Capital Radio
31 December 1973 Glasgow Radio Clyde
19 February 1974 Birmingham BRMB
2 April 1974 Manchester Piccadilly Radio
15 July 1974 Newcastle-upon-Tyne Metro Radio
1 October 1974 Sheffield Radio Hallam
21 October 1974 Liverpool Radio City
30 September 1974 Swansea Swansea Sound (Sain Abertawe)
22 January 1975 Edinburgh Radio Forth
19 May 1975 Plymouth Plymouth Sound
24 June 1975 Stockton-on-Tees Radio Tees
3 July 1975 Nottingham Radio Trent
16 September 1975 Bradford Pennine Radio
14 October 1975 Portsmouth Radio Victory
28 October 1975 Ipswich Radio Orwell
12 April 1976 Wolverhampton Beacon Radio
8 March 1976 Reading Radio 210
16 March 1976 Belfast Downtown Radio
— — —
11 April 1980 Cardiff CBC Radio
23 May 1980 Coventry Mercia Sound
10 July 1980 Peterborough Hereward Radio
15 September 1980 Bournemouth 2CR (Two Counties Radio)
17 October 1980 Dundee Radio Tay
23 October 1980 Gloucester Severn Sound
7 November 1980 Exeter DevonAir Radio
14 November 1980 Perth Radio Tay
12 December 1980 Torbay DevonAir Radio
27 July 1981 Aberdeen Northsound Radio
1 September 1981 Leeds Radio Aire
7 September 1981 Leicester Centre Radio
12 September 1981 Southend-on-Sea Essex Radio
15 October 1981 Luton Chiltern Radio
27 October 1981 Bristol Radio West
4 December 1981 Ayr and Girvan Westsound Radio
10 December 1981 Chelmsford Essex Radio
23 February 1982 Inverness Moray Firth Radio
1 March 1982 Bedford Chiltern Radio
4 October 1982 Worcester Radio Wyvern
5 October 1982 Preston Red Rose Radio
12 October 1982 Swindon Wiltshire Radio
6 November 1982 Bury St Edmunds Saxon Radio
4 April 1983 Guildford County Sound
13 June 1983 Newport GB Radio
29 August 1983 Brighton Southern Sound Radio
5 September 1983 Stoke-on-Trent Signal Radio
5 September 1983 Wrexham Marcher Sound (Sain y Gororau)
17 April 1984 Kingston-upon-Hull Viking Radio
1 October 1984 Norwich Radio Broadland
1 October 1984 Northampton Hereward Radio
1 October 1984 East Kent Invicta Sound
20 October 1984 Crawley Radio Mercury

Extension of ILR

In the late 1980s, the expansion of ILR continued at a similar rate. Under the Broadcasting Acts, the IBA had a duty to ensure that any area it licensed for radio could support a station with the available advertising revenue. Therefore, many areas were not included in the IBA's ILR plans as it was felt that they were not viable. This did not prevent Radio West in Bristol getting into financial trouble and having to merge with Wiltshire Radio on 1 October 1985; nor did it prevent Centre Radio going into receivership on 6 October 1983.

Split services

Nevertheless, the areas served by ILR continued to increase and 1986 the IBA sanctioned in principle the idea that different services could be broadcast on each station's FM and AM frequency. The first experimental part time split service was provided by Radio Forth, who created Festival City Radio for the duration of the Edinburgh Festival in 1984 . The first station to permanently split their frequencies was Guildford's County Sound who rebranded the FM output as Premier Radio and turned the AM output into a new golden oldies station, County Sound Gold in 1988. Other stations then followed suit.

By 1988, the government had decided that the practice of splitting was beneficial and a quick way to increase choice for listeners. The IBA then began a programme of encouraging ILR stations to split their services and most stations had soon complied. The usual format was to have a "gold" (oldies) service on AM and pop music on FM, although Radio City tried "City Talk" on AM before abandoning the format.

The Broadcasting Act 1990

The 1990 Broadcasting Act provided for the abolition of the IBA and its replacement by the Independent Television Commission. The IBA continued to regulate radio under the new name of the Radio Authority, but with a different remit.

As a "light-touch" regulator (although heavier than the ITC), the Radio Authority was to issue licences to the highest bidder and promote the development of commercial radio choice .

INR, RSLs, SALLIES and IRR

This led to the awarding of three national contracts (known as Independent National Radio, but still usually referred to under the banner of "ILR" by most commentators) to Classic FM, Virgin 1215 (later Virgin Radio) and Talk Radio (later talkSPORT).

The Radio Authority also began to licence Restricted Service Licence (RSL) stations - low-power temporary radio stations for special events, operating for up to 28 days a year - and to reduce the criteria for a "viable service area" with the introduction of Small Scale Local Licences (SALLIES) for villages, special interest groups and small communities .

At this point in time the AM waveband had become unpopular with radio groups and the majority of new stations were awarded an FM licence only, even when an AM licence was jointly available.

The Radio Authority also introduced regional stations (Independent Regional Radio, again usually grouped under the banner "ILR" by most commentators) and began to licence the commercial Digital Audio Broadcasting (DAB) multiplexes in October 1998 .

The Radio Authority was replaced by the Office of Communications (Ofcom) in 2004, which also replaced the ITC, the Broadcasting Standards Commission, the Radio Communications Agency and the Office of Telecommunications (Oftel). Ofcom has stated that they plan to continue the development of Independent Local Radio, with an emphasis on digital broadcasting, and to "ensure the character" of local stations, following the mergers and loss of local identities that followed the 1990 Act .

ILR stations

As of 2005, there are 217 licensed analogue ILR and IRR services in England; 16 in Wales; 34 in Scotland; 8 in Northern Ireland; and 2 in the Channel Islands. It should be noted that these are licences rather than stations - some licences are grouped nationally, regionally or by format to provide one service; other licences cover two or more services .

There are three national analogue services. There is one national DAB service (Digital One) and 47 regional DAB services, owned by 10 companies and operated by 9 .

Manx Radio

The first licensed commercial radio station in the United Kingdom is often stated to be Manx Radio, which launched in June 1964. However, since the Isle of Man is not part of the United Kingdom, Manx Radio is not considered to be an ILR station and launched with a Post Office licence. Manx Radio is funded by a mixture of commercial advertising and a yearly ￡860,000 Manx Government subvention.

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