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Fareh S, Nardi S, Argenziano L, Diamante A, Scala F, Mandurino C, Magnocavallo M, Poggio L, Scarano M, Gianfrancesco D, Palma F, Silvetti MS, Porcelli D, Racheli M, Montoy M, Charles P, Campari M, Valsecchi S, Lavalle C. Implantation of a novel insertable cardiac monitor: preliminary multicenter experience in Europe. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01821-y. [PMID: 38755520 DOI: 10.1007/s10840-024-01821-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The LUX-Dx™ is a novel insertable cardiac monitor (ICM) introduced into the European market since October 2022. PURPOSE The aim of this investigation was to provide a comprehensive description of the ICM implantation experience in Europe during its initial year of commercial use. METHODS The system comprises an incision tool and a single-piece insertion tool pre-loaded with the small ICM. The implantation procedure involves incision, creation of a device pocket, insertion of the ICM, verification of sensing, and incision closure. Patients receive a mobile device with a preloaded App, connecting to their ICM and transmitting data to the management system. Data collected at European centers were analyzed at the time of implantation and before patient discharge. RESULTS A total of 368 implantation procedures were conducted across 23 centers. Syncope (235, 64%) and cryptogenic stroke (34, 9%) were the most frequent indications for ICM. Most procedures (338, 92%) were performed in electrophysiology laboratories. All ICMs were successfully implanted in the left parasternal region, oriented at 45° in 323 (88%) patients. Repositioning was necessary after sensing verification in 9 (2%) patients. No procedural complications were reported, with a median time from skin incision to suture of 4 min (25th-75th percentiles 2-7). At implantation, the mean R-wave amplitude was 0.39 ± 0.30 mV and the P-wave visibility was 91 ± 20%. Sensing parameters remained stable until pre-discharge and were not influenced by patient characteristics or indications. Procedural times were fast, exhibited consistency across patient groups, and improved after an initial experience with the system. Operator Operator feedback on the system was positive. Patients reported very good ease of use of the App and low levels of discomfort after implantation. CONCLUSIONS LUX-Dx™ implantation appears efficient and straightforward, with favorable post-implantation sensing values and associated with positive feedback from operators and patients.
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Affiliation(s)
- S Fareh
- Department of Cardiology, Hôpital de La Croix Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Gd Rue de La Croix-Rousse, 69004, Lyon, France.
| | - S Nardi
- Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | | | - A Diamante
- Casa Di Cura "Villa Azzurra", Siracusa, Italy
| | - F Scala
- Fatebenefratelli Hospital, Naples, Italy
| | - C Mandurino
- Santissima Annunziata" Hospital, Taranto, Italy
| | | | - L Poggio
- Ospedale Maggiore Di Lodi, Lodi, Italy
| | - M Scarano
- Madonna del Soccorso" Hospital, San Benedetto del Tronto (AP), Italy
| | | | - F Palma
- Mons. Dimiccoli" Hospital, Barletta, Italy
| | | | - D Porcelli
- San Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - M Racheli
- San Pellegrino Hospital, Castiglione Delle Stiviere (MN), Italy
| | - M Montoy
- Department of Cardiology, Hôpital de La Croix Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Gd Rue de La Croix-Rousse, 69004, Lyon, France
| | - P Charles
- Department of Cardiology, Hôpital de La Croix Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Gd Rue de La Croix-Rousse, 69004, Lyon, France
| | - M Campari
- Boston Scientific Italia, Milan, Italy
| | | | - C Lavalle
- Department of Cardiovascular, Respiratory, NephrologicalAnesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
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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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Pitman BM, Zanker A, Lim M, McLoughney J, Spinelli J, Tarone R, McInnes K, Heath KM, Gieve M, Evans S, Young GD, Roberts-Thomson KC, Wong CX, Sanders P, Lau DH. Factors affecting electrogram sensing in an insertable cardiac monitor: Insights from surface electrocardiogram mapping analysis. Heart Rhythm 2023; 20:1297-1306. [PMID: 37321384 DOI: 10.1016/j.hrthm.2023.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fidelity of electrogram sensing may reduce false alerts from an insertable cardiac monitor (ICM). OBJECTIVE The purpose of this study was to assess the effect of vector length, implant angle, and patient factors on electrogram sensing using surface electrocardiogram (ECG) mapping. METHODS Twelve separate precordial single-lead surface ECGs were acquired from 150 participants at 2 interelectrode distances (75 and 45 mm), at 3 vector angles (vertical, oblique, and horizontal), and in 2 postures (upright and supine). A subset of 50 patients also received a clinically indicated ICM implant in 1:1 ratio (Reveal LINQ [Medtronic, Minneapolis, MN]/BIOMONITOR III [Biotronik, Berlin, Germany]). All ECGs and ICM electrograms were analyzed by blinded investigators using DigitizeIt software (V2.3.3, Braunschweig, Germany). The P-wave visibility threshold was set at > 0.015 mV. Logistic regression was used to identify factors affecting P-wave amplitude. RESULTS A total of 1800 tracings from 150 participants (44.5% [n = 68] female; median age 59 [35-73] years) were assessed. The median P- and R-wave amplitudes were 45% and 53% larger with vector lengths of 75 and 45 mm, respectively (P < .001 for both). The oblique orientation yielded the best P- and R-wave amplitudes, while posture change did not affect P-wave amplitude. Mixed effects modeling found that visible P-waves occur more frequently with a vector length of 75 mm than with 45 mm (86% vs 75%, respectively; P < .0001). A longer vector length improved both P-wave amplitude and visibility in all body mass index categories. There was a moderate correlation of P- and R-wave amplitudes from the ICM electrograms to those from surface ECG recordings (intraclass correlation coefficient 0.74 and 0.80, respectively). CONCLUSION Longer vector length and oblique implant angle yielded the best electrogram sensing and are relevant considerations for ICM implantation procedures.
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Affiliation(s)
- Bradley M Pitman
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Zanker
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew Lim
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua McLoughney
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jade Spinelli
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rachel Tarone
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kristie McInnes
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kyle M Heath
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mahsa Gieve
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shaun Evans
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Christopher X Wong
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia.
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Kida H, Kawasaki M, Kikuchi Y, Okada K, Watanabe T, Yamada T. Electrocardiographic characteristics for the prediction of under-sensing in implantable loop recorders. J Arrhythm 2022; 38:1063-1069. [PMID: 36524036 PMCID: PMC9745473 DOI: 10.1002/joa3.12782] [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: 04/19/2022] [Revised: 08/18/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Under-sensing (US) in implantable loop recorders (ILRs) interferes with the accurate diagnosis of arrhythmia, but there is little information available on the details of US of ILRs. The aim of this study was to clarify the frequency of US in patients with ILRs and to investigate the predictors of US in ILRs prior to implantation. Methods and Results We studied 46 consecutive patients implanted ILR. During the mean follow-up period of 499 ± 363 days, 15 events of US were observed in five patients. There were no significant differences in patient characteristics between patients with and without US. In standard 12-lead electrocardiogram (ECG), QRS complex amplitude in anterolateral chest leads (V2 to V5) were significantly lower in patients with than without US (V2: 0.88 [0.66, 1.22] mV vs. 1.67 [1.23, 2.29] mV, p = .010 V3: 1.25 [1.00, 1.26] mV vs. 1.90 [1.41, 2.29] mV, p = .013; V4: 1.14 [0.96, 1.38] mV vs. 1.93 [1.65, 2.64] mV, p = .023; V5: 0.57 [0.50, 0.75] mV vs. 1.60 [1.20, 1.98] mV, p = .011, respectively). ROC curve analysis showed that cut-off values of 1.30 mV of QRS complex amplitude in V2, 1.26 mV of that in V3, and 0.75 mV of that in V5 had moderate accuracy for predicting US (V2: sensitivity 68%, specificity 100%, area under the curve [AUC] 0.86; V3: sensitivity 85%, specificity 80%, AUC 0.85; V5: sensitivity 98%, specificity 80%, AUC 0.85, respectively). Conclusions US was observed in 10.9% patients with an ILR. QRS complex amplitude in anterolateral chest leads (V2 to V5) on ECG might be useful for predicting US in patients with ILRs.
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Affiliation(s)
- Hirota Kida
- Department of Clinical EngineeringOsaka General Medical CenterOsakaJapan
| | - Masato Kawasaki
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Yoshitaka Kikuchi
- Department of Clinical EngineeringOsaka General Medical CenterOsakaJapan
| | - Kana Okada
- Department of Clinical EngineeringOsaka General Medical CenterOsakaJapan
| | | | - Takahisa Yamada
- Division of CardiologyOsaka General Medical CenterOsakaJapan
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Kasai Y, Kasai J, Sahashi S, Shakya S, Kuji H, Hayakawa N, Miyaji K, Kanda J. Revisiting where to apply preimplant mapping to improve P-wave sensing of insertable cardiac monitors. J Arrhythm 2022; 38:622-632. [PMID: 35936046 PMCID: PMC9347200 DOI: 10.1002/joa3.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are used for long-term cardiac rhythm monitoring. They have proven useful in diagnosing arrhythmias. They are conventionally inserted at the 4th intercostal space without preimplant mapping. Method We develop a new method, VisP, that finds an optimal insertion position by applying the lightweight preimplant mapping to nine candidate positions beyond the conventional ones. We retrospectively analyze consecutive 60 patients who underwent ICM insertion (Reveal LINQ™) between April 2019 and March 2021 and compare the two groups with and without VisP. Results After 9 patients were excluded because of ectopic atrial rhythms or atrial fibrillation, 51 patients were analyzed. Thirty-one patients underwent the conventional insertion (non-mapping), whereas 20 patients underwent VisP. VisP achieved large P-wave amplitudes while retaining the R-wave amplitude for all patients; in contrast, P waves were not detected for 11 patients out of the 31 patients in the non-mapping group (35%). On average, the P-wave amplitude was 0.065 mV for VisP, compared to 0.029 mV for the non-mapping group (p-value< .001). The average R-wave amplitude was 0.69 mV for VisP and 0.71 mV for non-mapping (p-value = .88), indicating the R-wave difference is insignificant between the two groups. VisP selected the 4th, 3rd, and 2nd intercostal spaces for 7, 11, and 2 patients, respectively, meaning that 13 out of the 20 cases (65%) fell out of the conventional insertion location of the 4th intercostal space. Conclusions VisP improves the diagnostic ability of ICMs by finding an optimal position that yields reliable sensing of P waves while keeping high R-wave sensing.
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Affiliation(s)
- Yuhei Kasai
- Department of CardiologyKokuho Asahi Chuo HospitalChibaJapan
| | - Jungo Kasai
- Paul G. Allen School of Computer Science & EngineeringUniversity of WashingtonSeattleWAUSA
| | - Syuichi Sahashi
- Department of CardiologyKokuho Asahi Chuo HospitalChibaJapan
| | - Sandeep Shakya
- Department of CardiologyKokuho Asahi Chuo HospitalChibaJapan
| | - Hiroki Kuji
- Department of CardiologyKokuho Asahi Chuo HospitalChibaJapan
| | - Naoki Hayakawa
- Department of CardiologyKokuho Asahi Chuo HospitalChibaJapan
| | - Kotaro Miyaji
- Department of CardiologyKokuho Asahi Chuo HospitalChibaJapan
| | - Junji Kanda
- Department of CardiologyKokuho Asahi Chuo HospitalChibaJapan
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Kanjwal K, Kichloo A, Qadir R, Grubb BP. Further Observations on the Use of Pacemakers in Patients with Postural Orthostatic Tachycardia Syndrome with Demonstrated Asystole. J Innov Card Rhythm Manag 2021; 12:4447-4450. [PMID: 33777484 PMCID: PMC7987426 DOI: 10.19102/icrm.2021.120307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/15/2020] [Indexed: 12/02/2022] Open
Abstract
A subgroup of postural orthostatic tachycardia syndrome (POTS) patients may also have features of neurocardiogenic syncope (NCS). Syncope and presyncope are predominant clinical features in this subgroup of patients. Asystole has been reported as the cause of some recurrent syncopal episodes following evaluation with an implantable loop recorder (ILR). We present our experience of pacing in a group of patients with POTS and NCS, which resulted in the complete elimination of syncope. We reviewed the charts of 500 patients at the University of Toledo Medical Center from 2003 to 2013 and identified 40 patients who were eligible for inclusion in this study. Patients were included in this study if they had clinical features of POTS and unusually frequent episodes of syncope. All study participants subsequently underwent ILR implantation. Forty patients, including 32 (80%) women, aged 33 ± 13 years were included in this study. All patients demonstrated prolonged asystole (> 6 seconds) or severe bradycardia (heart rate < 30 bpm) during their syncope. Ten patients demonstrated an asystole of more than 10 seconds and also had prolonged and convulsive syncope. All patients had abrupt syncope without any warning signs. All 40 patients underwent dual-chamber pacemaker implantation. Syncope was eliminated in all 40 patients following pacemaker implantation; however, they continued to experience orthostatic tachycardia. Our findings support that dual-chamber pacing may help to eliminate syncope in a subgroup of POTS patients with recurrent syncope and prolonged asystole on ILR.
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Affiliation(s)
- Khalil Kanjwal
- Division of Cardiology, McLaren Greater Lansing Hospital, Michigan State University, Lansing, MI, USA
| | - Asim Kichloo
- Division of Internal Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Rehana Qadir
- Division of Internal Medicine, McLaren Greater Lansing Hospital, Michigan State University, Lansing, MI, USA
| | - Blair P Grubb
- Division of Cardiology, University of Toledo, Toledo, OH, USA
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De Coster M, Demolder A, De Meyer V, Vandenbulcke F, Van Heuverswyn F, De Pooter J. Diagnostic accuracy of R-wave detection by insertable cardiac monitors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:511-517. [PMID: 32259309 DOI: 10.1111/pace.13912] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Insertable cardiac monitors (ICM) allow prolonged rhythm monitoring, but the diagnostic performance can be hampered by false positive arrhythmia alerts related to inadequate R-wave sensing. This study assesses the prevalence and predictors of inadequate R-wave sensing (both over- and undersensing) among different ICM types. METHODS Patients implanted with an ICM at Ghent University Hospital between January 2017 and August 2018 were included. ICM tracings recorded at interrogation or transmitted by remote monitoring were reviewed for inadequate R-wave sensing leading to false arrhythmia alerts. Patient and implant characteristics were retrieved from the medical records and implant reports. RESULTS The study screened 135 patients (age 59 ± 19 years, 44% female) implanted with different ICM types: Reveal LINQ™ and XT (Medtronic): n = 92 (68%), Confirm and Confirm Rx (Abbott): n = 35 (26%), and BioMonitor 2 (Biotronik): n = 8 (6%). ICM tracings were analyzed in 112 patients (83%). False arrhythmia alerts occurred in 22 (20%) patients, most frequently related to undersensing (77%). False diagnosis of bradycardia or pause was documented in 64%, false high ventricular rates in 14%, and false atrial fibrillation alerts in 22%. Occurrence of R-wave changes was not related to patient characteristics or implant R-wave sensing. A trend toward higher number of inadequate R-wave sensing seems to occur with nonparasternal implant sites (P = .074). CONCLUSIONS False arrhythmia alerts due to inadequate R-wave sensing occurred in 20% of ICM patients independent of implant features and patient characteristics.
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Affiliation(s)
- Margot De Coster
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Anthony Demolder
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Veerle De Meyer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Kanjwal K, Qadir R, Ruzieh M, Grubb BP. Role of implantable loop recorders in patients with postural orthostatic tachycardia syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1201-1203. [PMID: 29989177 DOI: 10.1111/pace.13441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We previously reported on a subgroup of postural orthostatic tachycardia syndrome (POTS) patients who may also have features of neurocardiogenic syncope as well. In this subgroup of patients, we found syncope and presyncope were predominant clinical features. To understand the mechanism of syncope in this subgroup, we identified 39 patients who underwent loop recorder insertion. METHODS We reviewed charts of 450 patients who had POTS and syncope seen at the University of Toledo Medical Center from 2003 to 2017. Thirty-nine patients had at least four episodes of syncope in the last 6 months and were included for this study. All of these patients had a prior evaluation with a Holter and an event monitor which were inconclusive. RESULTS Thirty-nine patients, 33 (85%) women, aged 20-46 years, were included in this study. All patients demonstrated prolonged asystole (>6 seconds) or severe bradycardia (heart rate < 30 beats/min) during their syncope on implantable loop recorder (IRL). Fifteen patients demonstrated an asystole of >10 seconds and also had prolonged and convulsive syncope. All patients had abrupt syncope without any warning sign. All patients underwent dual-chamber pacemaker implantation using a closed loop stimulation algorithm. Syncope were completely eliminated in all patients following pacemaker implantation; however, they continued to have orthostatic tachycardia. CONCLUSION POTS patients with unusually frequent syncope should be considered for ILR implantation if other monitoring modalities like 48-hour Holter monitor or event recorder are inconclusive. ILR may identify a subgroup of POTS patients who may benefit from pacemaker implantations.
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Affiliation(s)
| | - Rehana Qadir
- McLaren Greater Lansing Hospital, Lansing, MI, USA
| | | | - Blair P Grubb
- University of Toledo Medical Center, Toledo, OH, USA
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Rogers JD, Sanders P, Piorkowski C, Sohail MR, Anand R, Crossen K, Khairallah FS, Kaplon RE, Stromberg K, Kowal RC. In-office insertion of a miniaturized insertable cardiac monitor: Results from the Reveal LINQ In-Office 2 randomized study. Heart Rhythm 2017; 14:218-224. [DOI: 10.1016/j.hrthm.2016.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lauschke J, Busch M, Haverkamp W, Bulava A, Schneider R, Andresen D, Nägele H, Israel C, Hindricks G, Bänsch D. New implantable cardiac monitor with three-lead ECG and active noise detection. Herz 2016; 42:585-592. [DOI: 10.1007/s00059-016-4492-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 01/14/2023]
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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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Zaca V, Marcucci R, Parodi G, Limbruno U, Notarstefano P, Pieragnoli P, Di Cori A, Bongiorni MG, Casolo G. Management of antithrombotic therapy in patients undergoing electrophysiological device surgery. Europace 2015; 17:840-54. [DOI: 10.1093/europace/euu357] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/13/2014] [Indexed: 11/14/2022] Open
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Subbiah R, Chia PL, Gula LJ, Klein GJ, Skanes AC, Yee R, Krahn AD. Cardiac monitoring in patients with syncope: making that elusive diagnosis. Curr Cardiol Rev 2014; 9:299-307. [PMID: 23228074 PMCID: PMC3941093 DOI: 10.2174/1573403x10666140214120056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/25/2022] Open
Abstract
Elucidating the cause of syncope is often a diagnostic challenge. At present, there is a myriad of ambulatory
cardiac monitoring modalities available for recording cardiac rhythm during spontaneous symptoms. We provide a comprehensive
review of these devices and discuss strategies on how to reach the elusive diagnosis based on current evidencebased
recommendations.
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Affiliation(s)
| | | | | | | | | | | | - Andrew D Krahn
- London Health Sciences Centre, University Campus, C6-113, 339 Windermere Road, London, Ontario, Canada, N6A 5A5.
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Krahn AD, Pickett RA, Sakaguchi S, Shaik N, Cao J, Norman HS, Guerrero P. R-wave sensing in an implantable cardiac monitor without ECG-based preimplant mapping: results from a multicenter clinical trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:505-11. [PMID: 24299115 PMCID: PMC4282462 DOI: 10.1111/pace.12303] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 10/06/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Reducing the form factor of an implantable cardiac monitor (ICM) may simplify device implant. This study evaluated R-wave sensing at a range of electrode distances and a preferred device implant location without mapping. METHODS Patients scheduled for a Medtronic Reveal® ICM implant (Medtronic Inc., Minneapolis, MN, USA) underwent a preimplant pocket recording using a diagnostic recording catheter. The ICM implant location was left to the discretion of the implanting physician, but a "recommended" position spanned the V2 -V3 electrocardiogram electrode location in an oblique 45° angle. R-wave amplitudes were analyzed from ICM follow-up. RESULTS Seventeen of 41 subjects (15 male, age 57 ± 16 years) had the maximum surface-filtered R-wave at the recommended location. Fourteen patients underwent diagnostic recording across the range of electrode spacing. There was a strong correlation between the R-wave amplitude and electrode distance (r(2) = 0.97, P < 0.001) with an increase of 29 μV per 2.5 mm. Comparing normalized R-wave distributions between the recommended ICM implant group (Group 1, n = 19) and the remaining patients (Group 2, n = 7), the proportion of ICM R-wave counts of amplitude 0.25-1.2 mV was higher (79% vs 46%, P < 0.05). Of 17 patients in Group 1 who had ≥ 1-month ICM follow-up (79 ± 45 days), no sensing-related false arrhythmia detection was found in 16 (93%) patients. CONCLUSIONS The subcutaneous R-wave amplitude correlates with electrode spacing in the implant zone of ICM patients. Implant locations at the V2 -V3 position at a 45° angle offer an adequate R wave for sensing. Preimplant mapping to achieve acceptable R-wave amplitude may not be necessary.
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Affiliation(s)
- Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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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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Korantzopoulos P, Letsas KP, Liu T, Fragakis N, Efremidis M, Goudevenos JA. Anticoagulation and antiplatelet therapy in implantation of electrophysiological devices. Europace 2011; 13:1669-1680. [PMID: 21788280 DOI: 10.1093/europace/eur210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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