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Introduction The ECS guidelines give a class I recommendation for ILR implant where there is recurrent syncope of uncertain origin. ILRs are increasingly used for other diagnostic purposes such as detection of atrial fibrillation and intrusive palpitations.ILRs have demonstrated a good diagnostic yield for arrhythmia, with lower cost per arrhythmia diagnosis compared to usual care.We present a 3 year retrospective data for a predominantly nurse led ILR implant service evaluating the diagnostic value of the ILR.The main endpoint of the study was the diagnostic yield - number of definitive diagnoses made.Method Consecutive patients who underwent ILR implantation (Reveal LINQ) from April 2020 and April 2023 were retrospectively analysed. Clinical characteristics of patients, procedural data and outcomes were collected. Evaluation focused on indication for implantation, cardiac rhythm findings and subsequent management.Results A total of 256 patients (303 events) were analysed in this study with 52% recording clinically significant arrhythmia ( table 1) and 48% demonstrating sinus rhythm, supraventricular/ventricular ectopics or sinus tachycardia. Patient distribution showed 52% females and 48% males, with ages between 19 and 94 (mean 67 with SD 17).A complication rate of 3.9% was recorded, with 1.5% rate of infection, 1.2% erosion, 1.2% pain or discomfort.Indications for implantation included syncope (52%), palpitations (29%), pre-syncope (11%), bradycardia (5%), CVA (3%) and HCM (0.4%), with some patients having more than 1 symptom.According to indications, arrhythmic findings were recorded in 51% of syncope patients, 70% of palpitations, 54% of pre-syncope, 79% of bradycardia and 14% of CVA patients.Further intervention was undertaken in 80 patients. In cases of syncope, 39 underwent a permanent pacemaker implantation.In 51 patients with palpitations and arrhythmic findings, 41 had medication changes with beta blockade, antiarrhythmics or anticoagulation. 13 cases were referred to an Electrophysiology service for consideration of ablation.Abstract 4-026 Table 1 Syncope Palpitations Pre-syncope Bradycardia CVA Total 134 73 28 14 7 Cases with arrhythmic findings 68 (51%) 51 (70%) 15 (54%) 11 (79%) 1 (14%) Significant sinus node disease 41% 6% 33% 64% - Atrial fibrillation / flutter 21% 49% 33% 27% 100% Paroxysmal AF with significant pauses 13% - - - - Conduction disease 12% - 7% 9% - Narrow complex tachycardia 4% 10% 7% - - Supraventricular tachycardia 3% 29% 7% - - Broad complex tachycardia 3% 4% 13% - - Ventricular tachycardia 1% 2% - - - Narrow and broad complex tachycardia 1% - - - - Conclusion In our centre, ILR implantation showed good diagnostic yield regardless of indication which compares well with the existing data in the literature. It detected clinically significant arrhythmia in 52% of patients and intervention was undertaken in 80 patients.