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Garcia-Fernández FJ, Martín González J, Villagraz Tercedor L, Fernández Palacios G, Cantero D, Vallés E, Trucco E. Feasibility, safety, and comfort of the '2BB' (2 cm below the bra) position of insertable cardiac monitors in women: the IN-WOMEN-ICM pilot study. Europace 2024; 26:euae080. [PMID: 38569064 PMCID: PMC11017509 DOI: 10.1093/europace/euae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- F Javier Garcia-Fernández
- Arrythmia Unit, Cardiology Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006 Burgos, Spain
| | - Javier Martín González
- Arrythmia Unit, Cardiology Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006 Burgos, Spain
| | - Lola Villagraz Tercedor
- Arrythmia Unit, Cardiology Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006 Burgos, Spain
| | - Gonzalo Fernández Palacios
- Arrythmia Unit, Cardiology Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006 Burgos, Spain
| | - Daniel Cantero
- Arrythmia Unit, Cardiology Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006 Burgos, Spain
| | - Ermengol Vallés
- Arrythmia Unit, Cardiology Department, Hospital del Mar, Barcelona, Universidad Pompeu Fabra, Paseo marítimo de la Barceloneta 25, 08003 Barcelona, Spain
| | - Emilce Trucco
- Arrythmia Unit, Cardiology Department, Hospital Universitario de Girona Dr Josep Trueta, Spain Avinguda de França, S/N, 17007 Girona, Spain
- Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
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Beach CM, Richardson C, Paul T. The Evolving Role of Insertable Cardiac Monitors in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:413-420. [PMID: 37865515 DOI: 10.1016/j.ccep.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Insertable cardiac monitors (ICMs) have been used more frequently and in a wider variety of circumstances in recent years. ICMs are used for symptom-rhythm correlation when patients have potentially arrhythmogenic syncope and for less traditional reasons such as rhythm surveillance in patients with genetic arrhythmia syndromes or other diseases with high arrhythmia risk. ICMs have good diagnostic yield in pediatric patients and in adults with congenital heart disease and have a low rate of complications. Implantation techniques should take patient-specific factors into account to optimize diagnostic yield and minimize risk.
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Affiliation(s)
- Cheyenne M Beach
- Section of Pediatric Cardiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Chalese Richardson
- Zucker School of Medicine at Hofstra, The Cohen Children's Heart Center, Northwell Health Physician Partners, 1111 Marcus Avenue, Suite M15, New Hyde Park, NY 11042, USA
| | - Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen D-37075, Germany
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Anderson H, Dearani J, Qureshi MY, Holst K, O'Leary P, Cannon B, Wackel P. Placement of Reveal LINQ Device in the Left Anterior Axillary Position. Pediatr Cardiol 2020; 41:181-185. [PMID: 31745583 DOI: 10.1007/s00246-019-02242-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Implantable loop recorders (ILR) are utilized for long-term rhythm monitoring. Typical placement of the Medtronic Reveal LINQ along the left parasternal border may compromise the quality and/or feasibility of future imaging studies. We sought to evaluate the utility of placing an ILR in the left anterior axillary position and the impact on the quality of cardiac imaging. We reviewed patients from May 2017 to June 2018 who had placement of a Reveal LINQ device in the left anterior axillary position. Demographic, procedural, and clinical data were collected via retrospective review. Cardiac magnetic resonance imaging (MRI) studies were reviewed for image quality after ILR placement. Eight patients met inclusion criteria for this study (median age 6 years, 50% female). Six patients (75%) had an ILR placed in the operating room, while all others were placed in the electrophysiology lab. All patients demonstrated acceptable R waves for diagnostic evaluation (median = 0.85 mV, range 0.24-1.7 mV). Cardiac MRI was obtained in 7 patients following ILR placement with diagnostic image quality and no adverse events. One device was explanted 28 days after placement due to concern for possible infection. No other devices required removal or revision (median follow up duration 11 months, IQR 8-13.5). ILR placement in the left anterior axillary position can record adequate signals in pediatric patients. In addition, axillary ILR device position may allow for completion of cardiac imaging, particularly cardiac MRI, without significant artifacts which is critical for patients with congenital heart disease.
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Affiliation(s)
- Heather Anderson
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Yasir Qureshi
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kimberly Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Patrick O'Leary
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bryan Cannon
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Philip Wackel
- Division of Pediatric Cardiology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Miracapillo G, Addonisio L, Breschi M, DE Sensi F, Manfredini E, Corbucci G, Severi S, Barold SS. Left Axillary Implantation of Loop Recorder versus the Traditional Left Chest Area: A Prospective Randomized Study. Pacing Clin Electrophysiol 2016; 39:830-6. [PMID: 27119309 DOI: 10.1111/pace.12875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Based upon the results of a previous small pilot study, we present the results of a prospective single-center randomized study comparing the performance of the implantable loop recorder (ILR) at two implanting sites. METHODS A group of patients whose ILRs were implanted via a left axillary approach were compared with a group who received an ILR in the traditional left site of the chest. Follow-up (FU) was scheduled every 6 months or when symptoms occurred. All patients enrolled in the study had a complete FU from implantation to explantation. R- and P-wave amplitudes were measured at implantation and during FU. Explantation of the device was programmed at the end of service life or when ILR analysis resulted in a complete and exhaustive diagnosis. RESULTS Sixty-three patients were enrolled (70 ± 12 years, range: 21-92, 59% male): 31 standard and 32 with axillary access. The R-wave amplitude obtained with the new technique was comparable with that obtained with the standard procedure. The diagnostic accuracy of the ILR was comparable in the two groups. The axillary implantation procedure was slightly longer but no complications were observed. CONCLUSION This long-term randomized study confirmed that axillary access for ILR implantation is feasible, safe, well tolerated, and reliable in terms of device performance. Moreover, it is aesthetically superior to the standard approach and carries the potential of minimizing permanent scarring after ILR extraction.
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Affiliation(s)
| | - Luigi Addonisio
- Division of Cardiology, Misericordia Hospital, Grosseto, Italy
| | - Marco Breschi
- Division of Cardiology, Misericordia Hospital, Grosseto, Italy
| | | | | | - Giorgio Corbucci
- Formerly, Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Silva Severi
- Division of Cardiology, Misericordia Hospital, Grosseto, Italy
| | - S Serge Barold
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Abstract
Implantable loop recorders (ILRs) continuously monitor electrocardiographic signals and perform real-time analysis of heart rhythm for up to 36 months. ILRs are used to evaluate transitory loss of consciousness from possible arrhythmic origin, particularly unexplained syncope, and to evaluate difficult cases of epilepsy and unexplained falls, although current indications for their application in these areas are less clearly defined. This article analyzes the current indications for ILRs according the European Society of Cardiology guidelines on the management of syncope and the European Heart Rhythm Association guidelines on the use of implantable and external electrocardiogram loop recorders, and their limitations.
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Affiliation(s)
- Franco Giada
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, PF Calvi Hospital, Via Largo San Giorgio 3, Noale 30033, Venice, Italy.
| | - Angelo Bartoletti
- Cardiology Division and Syncope Centre, San Giovanni di Dio Hospital, Nuovo Ospedale S. Giovanni di Dio, Florence, Italy
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Giada F, Bertaglia E, Reimers B, Noventa D, Raviele A. Current and emerging indications for implantable cardiac monitors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1169-78. [PMID: 22530875 DOI: 10.1111/j.1540-8159.2012.03411.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Implantable cardiac monitors (ICMs) continuously monitor the patient's electrocardiogram and perform real-time analysis of the heart rhythm, for up to 36 months. The current clinical use of ICMs involves the evaluation of transitory symptoms of possible arrhythmic origin, such as unexplained syncope and palpitations. Moreover, ICMs can also be used for the evaluation of difficult cases of epilepsy and unexplained falls, though current indications for their application in these sectors are less clearly defined. Finally, the ability of new-generation ICMs to automatically record arrhythmic episodes suggests that these devices could also be used to study asymptomatic arrhythmias, and thus could be proposed for the long-term evaluation of the total (symptomatic and asymptomatic) arrhythmic burden in patients at risk of arrhythmic events. In particular, ICMs may have an emerging role in the management of patients with atrial fibrillation and in those at risk of ventricular arrhythmias.
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Affiliation(s)
- Franco Giada
- Cardiovascular Department, General Hospitals, Noale-Mirano, Venice, Italy.
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GRUBB BLAIRP, WELCH MARLENE, KANJWAL KHALIL, KARABIN BEVERLY, KANJWAL YOUSUF. An Anatomic-Based Approach for the Placement of Implantable Loop Recorders. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1149-52. [DOI: 10.1111/j.1540-8159.2010.02747.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Babikar A, Hynes B, Ward N, Oslizok P, Walsh K, Keane D. A retrospective study of the clinical experience of the implantable loop recorder in a paediatric setting. Int J Clin Pract 2008; 62:1520-5. [PMID: 17764457 DOI: 10.1111/j.1742-1241.2007.01389.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The implantable loop recorder (ILR) has proved highly efficacious in the management of syncope, presyncope and palpitations in selected populations. Limited information regarding patient selection and diagnostic yield exists in the paediatric setting. A retrospective evaluation of patients who underwent ILR implantation over a 66-month period, in a tertiary paediatric cardiology unit was conducted. Twenty-three patients (10 male, 13 female) following initial assessment and investigation, were referred for device implantation. The mean age at time of ILR insertion was 11.39 +/- 4.34 (range, 2.0-16.8) years. The indications for ILR were recurrent syncope (n = 11), presyncope (n = 3) or palpitations (n = 9). Four (17.4%) patients had structural heart disease, three (13%) had a positive family history of sudden cardiac death and one (4%) had perinatal arrhythmia. One patient required ILR repositioning, and pocket infection necessitated explantation in one further patient. Minimum follow-up was 7.8 months during which symptoms were reported in 15 (65.2%) patients post-ILR insertion. Eight (34.7%) remained asymptomatic. Of the 15 who experienced symptom recurrence, eight (53.3%) had an arrhythmia recorded. Tachycardias recorded were polymorphic ventricular tachycardia (n = 1) and supraventricular tachycardia (n = 5). Clinically significant bradycardias documented, included sinus arrest (n = 1) and Mobitz type II second degree atrioventricular block (n = 1). The ILR had a high diagnostic yield, enabling an arrhythmic or non-arrhythmic diagnosis in 65.2% of patients with recurrent syncope, presyncope or palpitations in a selected paediatric population.
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Affiliation(s)
- A Babikar
- Cardiac Arrhythmia Department, St Vincent's University Hospital, Dublin, Ireland
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Kothari DS, Riddell F, Smith W, Voss J, Skinner JR. Digital implantable loop recorders in the investigation of syncope in children: Benefits and limitations. Heart Rhythm 2006; 3:1306-12. [PMID: 17074636 DOI: 10.1016/j.hrthm.2006.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 07/14/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Conventional diagnostic methods for detecting arrhythmogenic causes of syncope in children are poor. Digital implantable loop recorders are of proven value in adults. OBJECTIVES The purpose of this study was to evaluate digital implantable loop recorders in the investigation of syncope in children. METHODS We reviewed the clinical and technical records of 18 consecutive patients (6 female and 12 male; age <or=16 years) who received an implantable loop recorder from 1999 to 2005. RESULTS Median age at implantation was 11.3 years (range 4.6-16.5 years). Median duration of the device in situ was 18 months (range 5-36 months). Median time to diagnosis was 6 months (range 1 day to 17 months). Two patients had a congenital heart defect. Ten children (56%) had an event, 9 (50%) of whom had diagnostic information; 5 (28%) had profound bradycardia or asystole; 2 (11%) had polymorphic ventricular tachycardia (VT); and 1 child had supraventricular tachycardia. One patient died, but the automatically activated recording was recorded over again after death. One child had sinus rhythm during syncope. One child with polymorphic VT had no auto-activation on two occasions, and the third activation was triggered by asystole after VT terminated. Sixteen patients (89%) had false-positive activations as a result of either artifact or sinus tachycardia. CONCLUSION The digital implantable loop recorder is a useful diagnostic modality in children with unexplained syncope. However, the automatic detection algorithm is imperfect, missing genuine polymorphic VT and frequently interpreting muscle tremors as VT. Because of continuous overwriting by automatic detection, genuine arrhythmias may be over-recorded by artifact.
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Affiliation(s)
- Darshan S Kothari
- Greenlane Pediatric & Congenital Cardiac Services, Starship Children, Auckland, New Zealand
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Affiliation(s)
- Frank A Fish
- Pediatrics and Medicine, Division of Pediatric Cardiology, Vanderbilt University, Nashville, TN 37232-9119, USA.
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