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Swale M, Delacroix S, Young G, Paul V, McSpadden L, Ryu K, Di Fiore D, Santos M, Tan I, Conradie A, Duong M, Schwarz N, Worthley S, Pavia S. R-wave amplitude changes with posture and physical activity over time in an insertable cardiac monitor. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 3:80-88. [PMID: 35493270 PMCID: PMC9043368 DOI: 10.1016/j.cvdhj.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are accepted tools in cardiac arrhythmia management. Consistent R-wave amplitude (RWA) is essential for optimal detection. Objectives Assess RWAs with posture/activities at insertion and at 30 days. Methods Participants (n = 90) with Confirm Rx™ ICM had RWAs measured in different postures (supine, right-side [RS], left-side [LS], sitting, and standing) and defined physical activities (including isometric push [IPUSH] and pull) at 2 time points. ICMs were inserted in 45° to sternum and parasternal orientations. Results There were significant reductions at insertion with RS, LS, sitting, or standing vs supine (reference position) (all P < .05). At 30 days, significant changes only occurred with LS and sitting (P < .05). Sex had an effect on RWAs, with females having significant variability at insertion (supine vs RS, LS, sitting, standing, and IPUSH; all P < .05). Males showed large RWA interpatient variabilities but minimal differences between positions vs supine. At 30 days, RS, LS, and sitting positions remained significant for females (P < .05), while in males RWAs were higher than at insertion for most postures and activities. The orientation 45° to sternum had consistently higher RWAs vs parasternal orientation at both time points (P < .0001). In females, ICM orientation had no significant effect on RWAs; however, in males the 45° to sternum produced higher RWAs. ICM movement from the insertion site showed no correlation with RWA changes. Conclusion The mean RWAs were higher at 30 days with less interparticipant and interpostural variability; males had higher RWAs compared to females; 45° to sternum orientation had higher RWAs; and ICM migration from the insertion site did not affect RWAs.
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Affiliation(s)
- Matthew Swale
- The Valley Private Hospital, Mulgrave, Victoria, Australia
| | - Sinny Delacroix
- Abbott, Sylmar, California
- GenesisCare, Leabrook, South Australia, Australia
- Address reprint requests and correspondence: Dr Sinny Delacroix, GenesisCare, 284 Kensington Rd, Leabrook, SA 5068, Australia.
| | - Glenn Young
- St. Andrew's Hospital, Adelaide, South Australia, Australia
| | - Vincent Paul
- St. John of God Murdoch Hospital, Murdoch, Queensland, Australia
| | | | | | - David Di Fiore
- Friendly Society Private Hospital, Bundaberg, Queensland, Australia
| | - Maria Santos
- St. Andrew's Hospital, Adelaide, South Australia, Australia
| | - Isabel Tan
- Perth Mount, Perth, Western Australia, Australia
| | - Andre Conradie
- Friendly Society Private Hospital, Bundaberg, Queensland, Australia
| | - MyNgan Duong
- GenesisCare, Leabrook, South Australia, Australia
| | | | | | - Stephen Pavia
- The Wesley Hospital, Auchenflower, Queensland, Australia
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Exploring the experiences of individuals with an insertable cardiac monitor: Making the decision for device insertion. Heart Lung 2019; 49:86-91. [PMID: 31399224 DOI: 10.1016/j.hrtlng.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the decision-making process for insertable cardiac monitors (ICM) in those with suspected arrhythmias. OBJECTIVE The purpose of this qualitative study was to describe how individuals make a decision to insert an ICM. METHODS A qualitative descriptive design was used. Data were analyzed using content analysis and constant comparison. NVivo 10 was used for data grouping and patterns. RESULTS Participants (N = 12) ranged in age from 41to 95. Most (n = 7) had the device inserted because of syncope or atrial fibrillation (AF), and others (n = 5) for cryptogenic stroke. Three categories emerged: pre-decision, definitive decision, and deliberated decision. Event symptoms, including physical, cognitive and emotional, and trust emerged as factors in decision-making. CONCLUSIONS Those who perceived their experience as life-threatening, trusted the healthcare provider and assented to the ICM insertion. Conversely, those who perceived symptoms as episodic, used other strategies to resolve symptoms prior to making the decision for insertion.
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Tada S, Shibata M, Ohno S, Haruki Y, Murakami H, Hotta D, Nojima M, Ruhnke GW. Investigation on the optimal implantation site and setting of Reveal LINQ ® avoiding interference with performance of transthoracic echocardiography. J Arrhythm 2018; 34:261-266. [PMID: 29951141 PMCID: PMC6009771 DOI: 10.1002/joa3.12037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The optimal implantation site of a new implantable cardiac monitor (ICM) named Reveal LINQ® may be limited based on a sufficient amplitude of R wave potential (AEP) acquisition because it is the same anatomic area used for transthoracic echocardiography (TTE). METHODS Among 18 healthy volunteers, we assessed AEPs in 3 combinations through parasternal placement of 2 electrodes, (i) in the 4th intercostal space (ICS; site A/setting a; A/a), (ii) the same setting in the 5th ICS (site B/setting a; B/a), and (iii) in a sagittal plane relative to the left sternal border at the 4th ICS (site A/setting b; A/b), and further measured AFPs in several body positions in all site-setting combinations: supine, left and right lateral decubitus, sitting, and standing. The degree of interference with TTE performance was assessed by placement of an imitation ICM in setting a at both sites A and B. RESULTS Only the AEPs in A/a and B/a met the criteria (AEP ≥ 0.3 mV) in all positions. The AEPs in the supine position with all combinations were higher than those achieved in other positions (P < .001). The imitation interfered with TTE performance at site A among 78% of subjects, but only 17% at site B (P = .0006). The end-diastolic dimension of the left ventricle at site A was decreased after the imitation placement (P = .028). At site B, all female subjects complained of discomfort because their brassieres overlaid the imitation. CONCLUSION The B/a combination is optimal; however, the personal discomfort related to brassieres should be considered.
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Affiliation(s)
- Shizuka Tada
- Department of Clinical Laboratory MedicineHokkaido Cardiovascular HospitalSapporoJapan
| | - Masayoshi Shibata
- Department of Clinical Laboratory MedicineHokkaido Cardiovascular HospitalSapporoJapan
| | - Seiko Ohno
- Department of Clinical Laboratory MedicineHokkaido Cardiovascular HospitalSapporoJapan
| | - Yasunobu Haruki
- Department of Clinical Laboratory MedicineHokkaido Cardiovascular HospitalSapporoJapan
| | - Hironori Murakami
- Department of CardiologyHokkaido Cardiovascular HospitalSapporoJapan
| | - Daisuke Hotta
- Department of CardiologyHokkaido Cardiovascular HospitalSapporoJapan
| | - Masanori Nojima
- Center for Translational ResearchThe Institute of Medical Science HospitalThe University of TokyoTokyoJapan
| | - Gregory W. Ruhnke
- Section of Hospital MedicineDepartment of MedicineUniversity of ChicagoChicagoILUSA
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Tanno K. Use of implantable and external loop recorders in syncope with unknown causes. J Arrhythm 2017; 33:579-582. [PMID: 29255504 PMCID: PMC5728713 DOI: 10.1016/j.joa.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022] Open
Abstract
The gold standard for diagnosing syncope is to elucidate the symptom-electrocardiogram (ECG) correlation. The ECG recordings during syncope allow physicians to either confirm or exclude an arrhythmia as the mechanism of syncope. Many studies have investigated the use of internal loop recorder (ILR), while few studies have used external loop recorder (ELR) for patients with unexplained syncope. The aim of this review is to clarify the clinical usefulness of ILR and ELR in the diagnosis and management of patients with unexplained syncope. Many observational and four randomized control studies have shown that ILR for patients with unknown syncope is a useful tool for early diagnosis and improving diagnosis rate. ILR also provides important information on the mechanism of syncope and treatment strategy. However, there is no evidence of total mortality or quality of life improvements with ILR. The diagnostic yield of ELR in patients with syncope was similar to that with ILR within the same timeframe. Therefore, ELR could be considered for long-term ECG monitoring before a patient switches to using ILR. A systematic approach and selection of ECG monitoring tools reduces health care costs and improves the selection of patients for optimal treatment possibilities.
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Affiliation(s)
- Kaoru Tanno
- Cardiovascular Division, Showa University Koto-Toyosu Hospital, 5-1-38 Toyosu Koto-Ku, Tokyo 135-8577, Japan
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Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M. External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study. Europace 2016; 18:1265-72. [PMID: 26519025 PMCID: PMC4974630 DOI: 10.1093/europace/euv311] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS SYNARR-Flash study (Monitoring of SYNcopes and/or sustained palpitations of suspected ARRhythmic origin) is an international, multicentre, observational, prospective trial designed to evaluate the role of external 4-week electrocardiogram (ECG) monitoring in clinical work-up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin. METHODS AND RESULTS Consecutive patients were enrolled within 1 month after unexplained syncope or palpitations (index event) after being discharged from emergency room or hospitalization without a conclusive diagnosis. A 4-week ECG monitoring was obtained by external high-capacity loop recorder (SpiderFlash-T(®), Sorin) storing patient-activated and auto-triggered tracings. Diagnostic monitorings included (i) conclusive events with reoccurrence of syncope or palpitation with concomitant ECG recording (with/without arrhythmias) and (ii) events with asymptomatic predefined significant arrhythmias (sustained supraventricular or ventricular tachycardia, advanced atrio-ventricular block, sinus bradycardia <30 b.p.m., pauses >6 s). SYNARR-Flash study enrolled 395 patients (57.7% females, 56.9 ± 18.7 years, 28.1% with syncope, and 71.9% with palpitations) from 10 European centres. For syncope, the 4-week diagnostic yield was 24.5%, and predictors of diagnostic events were early start of recording (0-15 vs. >15 days after index event) (OR 6.2, 95% CI 1.3-29.6, P = 0.021) and previous history of supraventricular arrhythmias (OR 3.6, 95% CI 1.4-9.7, P = 0.018). For palpitations, the 4-week diagnostic yield was 71.6% and predictors of diagnostic events were history of recurrent palpitations (P < 0.001) and early start of recording (P = 0.001). CONCLUSION The 4-week external ECG monitoring can be considered as first-line tool in the diagnostic work-up of syncope and palpitation. Early recorder use, history of supraventricular arrhythmia, and frequent previous events increased the likelihood of diagnostic events during the 4-week external ECG monitoring.
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Affiliation(s)
- E T Locati
- Department of Cardiovascular-Cardiology 3, Electrophysiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - A Moya
- Univeristy Hospital Vall d'Hebron, Barcelona, Spain University Hospital QuironDexeus, Barcelona, Spain
| | | | | | | | - M Lunati
- Department of Cardiovascular-Cardiology 3, Electrophysiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - M Brignole
- Lavagna Hospital, Lavagna, Genova, Italy
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Abstract
Insertable cardiac monitors (ICMs) are leadless subcutaneous devices that continuously monitor the heart rhythm and record events over a timeframe measured in years, allowing for the diagnosis of infrequent rhythm abnormalities that can be the cause of palpitations, syncope and stroke. To date, ICMs have primarily been used in the work-up and management of syncope; however, their use in other areas of rhythm evaluation, particularly atrial fibrillation monitoring, is increasing. The Reveal LINQ™ is the smallest and most versatile ICM available and represents a dramatic leap forward in ICM technology that has the potential to transform patient care in a number of circumstances. Device miniaturization, simplified implant procedure and enhanced automation vastly increase physician and patient acceptance. The next 5 years can be expected to bring a greatly increased use of ICMs for disease diagnosis and management in a variety of clinical settings.
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Affiliation(s)
- Todd T Tomson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, 676 North St. Claire, Suite 600, Chicago, IL 60611, USA
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Locati ET, Vecchi AM, Vargiu S, Cattafi G, Lunati M. Role of extended external loop recorders for the diagnosis of unexplained syncope, pre-syncope, and sustained palpitations. Europace 2013; 16:914-22. [PMID: 24158255 DOI: 10.1093/europace/eut337] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the diagnostic yield of new external loop recorders (ELRs) in patients with history of syncope, pre-syncope, and sustained palpitations. METHODS AND RESULTS Since 2005, we have established a registry including patients who consecutively received ELR monitoring for unexplained syncope or pre-syncope/palpitations. The registry included 307 patients (61% females, age 58 ± 19 years, range 8-94 years) monitored by high-capacity memory ELR of two subsequent generations: SpiderFlash-A(®) (SFA(®), Sorin CRM), storing two-lead electrocardiogram (ECG) patient-activated recordings by loop-recording technique (191 patients, 54 patients with syncope, years 2005-09), and SpiderFlash-T(®) (SFT(®)), adding auto-trigger detection for pauses, bradycardia, and supraventricular/ventricular arrhythmias (116 patients, 38 patients with syncope, years 2009-12). All the patients previously underwent routine workup for syncope or palpitation, including one or more 24 h Holter, not conclusive for diagnosis. Mean monitoring duration was 24.1 ± 8.9 days. Among 215 patients with palpitations, a conclusive diagnosis was obtained in 184 patients (86% diagnostic yield for palpitation). Among 92 patients with syncope, a conclusive diagnosis was obtained in 16 patients (17% clinical diagnostic yield for syncope), with recording during syncope of significant arrhythmias in 9 patients, and sinus rhythm in 7 patients. Furthermore, asymptomatic arrhythmias were de novo detected in 12 patients (13%), mainly by auto-trigger detection, suggesting an arrhythmic origin of the syncope. CONCLUSIONS The diagnostic yield of ELR in patients with syncope, pre-syncope, or palpitation of unknown origin after routine workup was similar to implantable loop recorder (ILR) within the same timeframe, therefore, ELR could be considered for patients candidate for long-term ECG monitoring, stepwise before ILR.
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Affiliation(s)
- Emanuela T Locati
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Anna Maria Vecchi
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Sara Vargiu
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Giuseppe Cattafi
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
| | - Maurizio Lunati
- Department of Cardiovascular, Cardiology Unit 3 - Electrophysiology, Niguarda Hospital, Milan, Italy
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Abstract
Electrocardiographic (ECG) monitoring is a well-established procedure in the work-up of patients with syncope or for diagnosing arrhythmias. The investigation of syncope remains, however, challenging and physicians have an increasing armamentarium of diagnostic tools available and with advances in technology the role of these tools has to be continuously evaluated. The gold standard for the diagnosis of syncope is a symptom-ECG correlation, and while many studies have investigated the use and indications of both short-term and long-term monitoring; there is still some uncertainty in their clinical utility and practical approach. The use of ECG monitoring and other diagnostic tools is often subject to a "shot-gun approach" rather than a strict guideline algorithm. A systematic approach and selection of ECG monitoring tools helps permit an effective usage of the limited health care resources available for the management of unexplained syncope. In this review we aim to focus and clarify the role of short-term (Holter and external loop recorders) and long-term (implantable loop recorders) ECG monitoring in the diagnosis and management of patients with unexplained syncope.
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Affiliation(s)
- Martin H Ruwald
- Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA.
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