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Quartieri F, Harish M, Calò L, Ebrahim I, Fusco A, Mester S, Cauti F, Park SJ, Francia P, Giovagnoni M, Adragao P, Vezi B, Lin W, Hutson CS, Grammatico A. New insertable cardiac monitors show high diagnostic yield and good safety profile in real-world clinical practice: results from the international prospective observational SMART Registry. Europace 2023; 25:euad068. [PMID: 36935638 PMCID: PMC10227665 DOI: 10.1093/europace/euad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/05/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Insertable cardiac monitors (ICMs) are indicated for long-term monitoring of unexplained syncope or palpitations, and for detection of bradycardia, ventricular tachycardia, and/or atrial fibrillation (AF). The aim of our study was to evaluate the safety and clinical value associated with a new generation ICM (Confirm Rx™, Abbott, Illinois, USA), featuring a new remote monitoring system based on smartphone patient applications. METHODS AND RESULTS The SMART Registry is an international prospective observational study. The main endpoints were ICM safety (incidence of serious adverse device and procedure-related events (SADEs) at 1 month), ICM clinical value (incidence of device-detected true arrhythmias and of clinical diagnoses and interventions), and patient-reported experience measurements (PREMs). A total of 1400 subjects were enrolled. ICM indications included syncope (49.1%), AF (18.8%), unexplained palpitations (13.6%), risk of ventricular arrhythmia (6.6%), and cryptogenic stroke (6.0%). Freedom from SADEs at 1 month was 99.4% (95% Confidence Interval: 98.8-99.7%). In the 6-month monitoring period, the ICM detected true cardiac arrhythmias in 45.7% of patients and led to clinical interventions in a relevant proportion of patients; in particular, a pacemaker implant was performed after bradycardia detection in 8.9% of subjects who received an ICM for syncope and oral anticoagulation therapy was indicated after AF detection in 15.7% of subjects with cryptogenic stroke. PREMs showed that 78.2% of subjects were satisfied with the remote monitoring patient app. CONCLUSION The evaluated ICM is associated with an excellent safety profile and high diagnostic yield. Patients reported positive experiences associated with the use of their smartphone for the device remote monitoring.
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Affiliation(s)
- Fabio Quartieri
- Arcispedale Santa Maria Nuova, Viale Risorgimento, 80, 42123 Reggio Emilia, Italy
| | - Manyam Harish
- Erlanger Medical Center, 975 E 3rd St, Chattanooga, TN 37403, USA
| | - Leonardo Calò
- Policlinico Casilino, Via Casilina, 1049, 00169 Roma, Italy
| | - Iftikhar Ebrahim
- Netcare Unitas Hospital, 866 Clifton Ave, Die Hoewes, Centurion, 0163, South Africa
| | - Antonio Fusco
- Casa di Cura Pederzoli, Via Monte Baldo 24, 37019 Peschiera del Garda, VeronaItaly
| | - Stephen Mester
- Bay Area Cardiology Associates, 635 Eichenfeld Dr, Brandon, FL 33511, USA
| | - Filippo Cauti
- Ospedale S. Giovanni Calibita Fatebenefratelli, Via di Ponte Quattro Capi 39, 00186 Rome, Italy
| | - Seung-Jung Park
- Samsung Medical Center, 81 Ilwon-ro, Gangnam-gu, 06351 Seoul, South Korea
| | - Pietro Francia
- Ospedale S. Andrea, Via di Grottarossa, 1035, 00189 Rome, Italy
| | - Marco Giovagnoni
- Casa Di Cura Citta di Aprilia, Via delle Palme, 25, 04011 Aprilia, Italy
| | - Pedro Adragao
- Hospital de Santa Cruz, Av. Prof. Dr. Reinaldo dos Santos, 2790, 134 Carnaxide, Lisbon, Portugal
| | - Brian Vezi
- Busamed Gateway Private Hospital, 36-38 Aurora Dr, Umhlanga Rocks, Umhlanga 4319, South Africa
| | - Wenjiao Lin
- Abbott, 15900 Valley View Ct, Sylmar, CA 91342, USA
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Signore F, Simone V, Anaclerio M, Bozza N, Marulli G, De Palma A. Successful uniportal thoracoscopic removal of a new generation implantable loop recorder accidentally migrated into the left pleural cavity and concomitant re-implantation: A case report. Int J Surg Case Rep 2023; 105:108012. [PMID: 36966716 PMCID: PMC10073884 DOI: 10.1016/j.ijscr.2023.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION With the spread of the use of implantable loop recorders (ILRs) by cardiologists for outpatient cardiac monitoring, intrathoracic migration represents a rare but possible complication occurring after the placement of these devices. Very few cases of ILRs intrathoracic migration into the pleural cavity have been reported, followed in even fewer cases by surgical removal of the devices, but in none re-implantation was performed. PRESENTATION OF CASE We report the first case of a patient with a new generation ILR accidentally migrated into the postero-inferior costophrenic recess of the left pleural cavity, successfully removed by uniportal video-assisted thoracic surgery (VATS) and submitted to re-implantation of a new ILR in the same operating session. DISCUSSION To reduce the risk of ILRs intrathoracic displacement, the insertion technique must be performed in the most suitable part of the chest wall, with the correct incision and angle of penetration, by an expert operator. When migrated into the pleural cavity, surgical removal should be performed to avoid the onset of early and late complications. A mini-invasive surgical approach by uniportal VATS could be considered as the first choice, ensuring a favourable patient outcome. Re-implantation of a new ILR can be safely performed in the same operating session. CONCLUSION In case of intrathoracic migration of ILRs, early removal by mini-invasive approach is recommended as well as concomitant re-implantation. Beyond periodic monitoring of ILRs by cardiologists, strict radiological follow-up with chest X-ray is advisable after implantation, in order to early identify any abnormalities and correctly manage them.
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Stolen C, Rosman J, Manyam H, Kwan B, Kelly J, Perschbacher D, Garner J, Richards M. Preliminary results from the LUX-Dx insertable cardiac monitor remote programming and performance (LUX-Dx PERFORM) study. Clin Cardiol 2022; 46:100-107. [PMID: 36208096 PMCID: PMC9849434 DOI: 10.1002/clc.23930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023] Open
Abstract
Despite the wide adoption of insertable cardiac monitors (ICMs), high false-positive rates, suboptimal signal quality, limited ability to detect atrial flutter, and lack of remote programming remain challenging. The LUX-Dx PERFORM study was designed to evaluate novel technologies engineered to address these issues. Here, we present preliminary results from the trial focusing on the safety of ICM insertion, remote monitoring rates, and the feasibility of remote programming. LUX-Dx PERFORM is a multicenter, prospective, single-arm, post-market, observational study with planned enrollment of up to 827 patients from 35 sites in North America. A preliminary cohort consisting of the first 369 patients who were enrolled between March and October 2021 was selected for analysis. Three hundred sixty-three (363) patients had ICM insertions across inpatient and outpatient settings. The mean time followed was 103.4 ± 61.8 days per patient. The total infection rate was 0.8% (3/363). Interim results show high levels of remote monitoring with a median 94% of days with data transmission (interquartile range: 82-99). Thirteen (13) in-clinic and 24 remote programming sessions were reported in 34 subjects. Reprogramming examples are presented to highlight signal quality, the ability to detect atrial flutter, and the positive impact of remote programming on patient management. Interim results from LUX-Dx PERFORM study demonstrate the safety of insertion, high data transmission rates, the ability to detect atrial flutter, and the feasibility of remote programming to optimize arrhythmia detection and improve clinical workflow. Future results from LUX-Dx PERFORM will further characterize improvements in signal quality and arrhythmia detection.
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Affiliation(s)
- Craig Stolen
- Cardiac Rythm ManagementBoston ScientificSt PaulMinnesotaUSA
| | - Jonathan Rosman
- Cardiac Arrhythmia ServiceFlorida Atlantic University CESCOMBoca RatonFloridaUSA
| | - Harish Manyam
- Department of Cardiology, Erlanger HospitalUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Brian Kwan
- Cardiac Rythm ManagementBoston ScientificSt PaulMinnesotaUSA
| | - Jonathan Kelly
- Cardiac Rythm ManagementBoston ScientificSt PaulMinnesotaUSA
| | | | - John Garner
- Department of Clinical MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Mark Richards
- Yakima Heart Lung & Vascular ClinicYakima Valley MemorialYakimaWashingtonUSA
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Swale M, Paul V, Delacroix S, Young G, McSpadden L, Ryu K, Di Fiore D, Santos M, Tan I, Conradie A, Duong M, Schwarz N, Worthley S, Pavia S. Changes in R-wave amplitude at implantation are associated with gender and orientation of insertable cardiac monitor: observations from the confirm Rx™ body posture and physical activity study. BMC Cardiovasc Disord 2022; 22:439. [PMID: 36209063 PMCID: PMC9548115 DOI: 10.1186/s12872-022-02752-0] [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: 01/06/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are small subcutaneously implanted devices that detect changes in R-wave amplitudes (RWAs), effective in arrhythmia-monitoring. Although ICMs have proven to be immensely successful, electrical artefacts are frequent and can lead to misdiagnosis. Thus, there is a growing need to sustain and increase efficacy in detection rates by gaining insight into various patient-specific factors such as body postures and activities. Methods RWAs were measured in 15 separate postures, including supine, lying on the right-side (RS) or left-side (LS) and sitting, and two separate ICM orientations, immediately after implantation of Confirm Rx™ ICM in 99 patients. Results The patients (53 females and 46 males, mean ages 66.62 ± 14.7 and 66.40 ± 12.25 years, respectively) had attenuated RWAs in RS, LS and sitting by ~ 26.4%, ~ 27.8% and ~ 21.2% respectively, compared to supine. Gender-based analysis indicated RWAs in RS (0.32 mV (0.09–1.03 mV), p < 0.0001) and LS (0.37 mV (0.11–1.03 mV), p = 0.004) to be significantly attenuated compared to supine (0.52 mV (0.20–1.03 mV) for female participants. Similar attenuation was not evident for male participants. Further, parasternally oriented ICMs (n = 44), attenuated RWAs in RS (0.37 mV(0.09–1.03 mV), p = 0.05) and LS (0.34 mV (0.11–1.03 mV), p = 0.02) compared to supine (0.48 mV (0.09–1.03 mV). Similar differences were not observed in participants with ICMs in the 45°-relative-to-sternum (n = 46) orientation. When assessing the combined effect of gender and ICM orientation, female participants demonstrated plausible attenuation in RWAs for RS and LS postures compared to supine, an effect not observed in male participants. Conclusion This is the first known study depicting the effects on RWA due to body postures and activities immediately post-implantation with an overt impact by gender and orientation of ICM. Future work assessing the cause of gender-based differences in RWAs may be critical. Trial registration: Clinical Trials, NCT03803969. Registered 15 January 2019 – Retrospectively registered, https://clinicaltrials.gov/NCT03803969
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Affiliation(s)
- Matthew Swale
- The Valley Private Hospital, Mulgrave, VIC, Australia
| | - Vincent Paul
- St. John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Sinny Delacroix
- Abbott, Sylmar, CA, USA. .,GenesisCare, Leabrook, 284 Kensington Road, Leabrook, SA, Australia.
| | - Glenn Young
- St. Andrew's Hospital, Adelaide, SA, Australia
| | | | | | - David Di Fiore
- Friendly Society Private Hospital, Bundaberg, QLD, Australia
| | | | | | - Andre Conradie
- Friendly Society Private Hospital, Bundaberg, QLD, Australia
| | - MyNgan Duong
- GenesisCare, Leabrook, 284 Kensington Road, Leabrook, SA, Australia
| | - Nisha Schwarz
- GenesisCare, Leabrook, 284 Kensington Road, Leabrook, SA, Australia
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Casella M, Compagnucci P, Conti MA, Falanga U, Volpato G, Fogante M, Cipolletta L, Misiani A, Molini S, Giovagnoni A, Dello Russo A. Recurrence of atrial fibrillation post-ablation: which is the most effective approach for detection? Minerva Cardiol Angiol 2022; 70:628-638. [PMID: 35212506 DOI: 10.23736/s2724-5683.22.05859-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last 20 years, catheter ablation of atrial fibrillation (AF) has evolved from a research tool into a fundamental therapeutic measure, with the potential to improve symptoms, quality of life, and even risk of major adverse cardiac events (among patients with heart failure and a reduced ejection fraction). Notwithstanding the tremendous evolution in techniques and tools, risk of AF recurrences post-ablation is not negligible, and a comprehensive structured follow-up is highly needed to deliver optimal patient care. In this follow-up process, monitoring of heart rhythm is quintessential to detect recurrences, and may be accomplished by means of symptoms-triggered, intermittent, or continuous monitors. In recent years, the development and widespread adoption of implantable cardiac monitors, by allowing continuous long-term rhythm assessment, has surged to become the gold-standard strategy, both in research settings and in clinical practice. In this review, we both summarize the present state-of-the art on the detection of post-ablation AF recurrences, and provide future perspectives on this emerging yet often neglected topic, aiming to give practical hints for evidence-based, personalized patient care.
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Affiliation(s)
- Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy.,Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy - .,Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Manuel A Conti
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Umberto Falanga
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Marco Fogante
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Agostino Misiani
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Silvano Molini
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
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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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Laske TG, Garshelis DL, Iles TL, Iaizzo PA. An engineering perspective on the development and evolution of implantable cardiac monitors in free-living animals. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200217. [PMID: 34121460 PMCID: PMC8200647 DOI: 10.1098/rstb.2020.0217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The latest technologies associated with implantable physiological monitoring devices can record multiple channels of data (including: heart rates and rhythms, activity, temperature, impedance and posture), and coupled with powerful software applications, have provided novel insights into the physiology of animals in the wild. This perspective details past challenges and lessons learned from the uses and developments of implanted biologgers designed for human clinical application in our research on free-ranging American black bears (Ursus americanus). In addition, we reference other research by colleagues and collaborators who have leveraged these devices in their work, including: brown bears (Ursus arctos), grey wolves (Canis lupus), moose (Alces alces), maned wolves (Chrysocyon brachyurus) and southern elephant seals (Mirounga leonina). We also discuss the potentials for applications of such devices across a range of other species. To date, the devices described have been used in fifteen different wild species, with publications pending in many instances. We have focused our physiological research on the analyses of heart rates and rhythms and thus special attention will be paid to this topic. We then discuss some major expected step changes such as improvements in sensing algorithms, data storage, and the incorporation of next-generation short-range wireless telemetry. The latter provides new avenues for data transfer, and when combined with cloud-based computing, it not only provides means for big data storage but also the ability to readily leverage high-performance computing platforms using artificial intelligence and machine learning algorithms. These advances will dramatically increase both data quantity and quality and will facilitate the development of automated recognition of extreme physiological events or key behaviours of interest in a broad array of environments, thus further aiding wildlife monitoring and management. This article is part of the theme issue ‘Measuring physiology in free-living animals (Part I)’.
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Affiliation(s)
- Timothy G Laske
- Department of Surgery, University of Minnesota, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - David L Garshelis
- Minnesota Department of Natural Resources (retired), 1201 E Hwy 2, Grand Rapids, MN 55744, USA
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Paul A Iaizzo
- Department of Surgery, University of Minnesota, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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Edwards SJ, Wakefield V, Jhita T, Kew K, Cain P, Marceniuk G. Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke: a systematic review and economic evaluation. Health Technol Assess 2021; 24:1-184. [PMID: 31944175 DOI: 10.3310/hta24050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after standard diagnostic tests. Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants. OBJECTIVES The objectives were to assess the diagnostic test accuracy, clinical effectiveness and cost-effectiveness of three implantable monitors [BioMonitor 2-AF™ (Biotronik SE & Co. KG, Berlin, Germany), Confirm Rx™ (Abbott Laboratories, Lake Bluff, IL, USA) and Reveal LINQ™ (Medtronic plc, Minneapolis, MN, USA)] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring. DATA SOURCES MEDLINE, EMBASE, The Cochrane Library, Database of Abstracts of Reviews of Effects and Health Technology Assessment databases were searched from inception until September 2018. REVIEW METHODS A systematic review was undertaken. Two reviewers agreed on studies for inclusion and performed quality assessment using the Cochrane Risk of Bias 2.0 tool. Results were discussed narratively because there were insufficient data for synthesis. A two-stage de novo economic model was developed: (1) a short-term patient flow model to identify cryptogenic stroke patients who have had atrial fibrillation detected and been prescribed anticoagulation treatment (rather than remaining on antiplatelet treatment) and (2) a long-term Markov model that captured the lifetime costs and benefits of patients on either anticoagulation or antiplatelet treatment. RESULTS One randomised controlled trial, Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL-AF) (Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014;370:2478-86), was identified, and no diagnostic test accuracy study was identified. The CRYSTAL-AF trial compared the Reveal™ XT (a Reveal LINQ predecessor) (Medtronic plc) monitor with standard of care monitoring. Twenty-six single-arm observational studies for the Reveal devices were also identified. The only data for BioMonitor 2-AF or Confirm Rx were from mixed population studies supplied by the companies. Atrial fibrillation detection in the CRYSTAL-AF trial was higher with the Reveal XT than with standard monitoring at all time points. By 36 months, atrial fibrillation was detected in 19% of patients with an implantable cardiac monitor and in 2.3% of patients receiving conventional follow-up. The 26 observational studies demonstrated that, even in a cryptogenic stroke population, atrial fibrillation detection rates are highly variable and most cases are asymptomatic; therefore, they probably would not have been picked up without an implantable cardiac monitor. Device-related adverse events, such as pain and infection, were low in all studies. The de novo economic model produced incremental cost effectiveness ratios comparing implantable cardiac monitors with standard of care monitoring to detect atrial fibrillation in cryptogenic stroke patients based on data for the Reveal XT device, which can be related to Reveal LINQ. The BioMonitor 2-AF and Confirm RX were included in the analysis by making a strong assumption of equivalence with Reveal LINQ. The results indicate that implantable cardiac monitors could be considered cost-effective at a £20,000-30,000 threshold. When each device is compared incrementally, BioMonitor 2-AF dominates Reveal LINQ and Confirm RX. LIMITATIONS The cost-effectiveness analysis for implantable cardiac monitors is based on a strong assumption of clinical equivalence and should be interpreted with caution. CONCLUSIONS All three implantable cardiac monitors could be considered cost-effective at a £20,000-30,000 threshold, compared with standard of care monitoring, for cryptogenic stroke patients with no atrial fibrillation detected after 24 hours of external electrocardiographic monitoring; however, further clinical studies are required to confirm their efficacy in cryptogenic stroke patients. STUDY REGISTRATION This study is registered as PROSPERO CRD42018109216. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven J Edwards
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | | | - Tracey Jhita
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | - Kayleigh Kew
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | - Peter Cain
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | - Gemma Marceniuk
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
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Zakhar J, Blount TJ, Gehi AK, Ferns SJ. Un-LINQed: Spontaneous extrusion of newer generation implantable loop recorders. Indian Pacing Electrophysiol J 2020; 20:189-192. [PMID: 32298763 PMCID: PMC7517543 DOI: 10.1016/j.ipej.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 11/27/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are often used for long-term monitoring of cardiac rhythm. The Medtronic’s LINQ Reveal ™ is a new generation wireless, automated, and patient responsive subcutaneous ECG monitoring device. Despite several advantages to its small size we have noted an unusually high incidence of extrusion at our center. Methods & Results: We conducted a retrospective case analysis to review Reveal LINQs implanted at our center. All devices were inserted using the provided insertion tools. Patients with extruded devices were identified and details regarding the site and technique of insertion, incision closure, use of peri-operative antibiotics, and follow-up details were collected. 81 patients underwent 85 Reveal LINQ implants at a tertiary care University Hospital referral center. The most common reason for implant was suspected arrhythmia with or without structural heart disease or unexplained syncope. There were 4 spontaneous extrusions occurring within 7–24 days after insertion with an incidence rate of 4.7%. One extruded device was anchored to subcutaneous tissue, and no pocket/device infections or hematomas were noted. Conclusions Device migration and erosion through skin are important potential adverse events for the Reveal LINQ implantable loop recorder. This study reports an unexpectedly high rate of extrusion without infection. The authors suggest that the depth of the incision is the main factor impacting extrusions. Larger studies are recommended, however, and a proposed measure to avoid spontaneous extrusion is the design of a longer manufacturer’s blade in order to increase the depth of the incision and insertion.
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Affiliation(s)
- Joseph Zakhar
- Department of Pediatrics, University of Colorado, Denver. 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Thomas J Blount
- Department of Pediatrics, Washington University School of Medicine, St Louis, 1Brooklings Drive, St Louis, MO, 63130, USA
| | - Anil K Gehi
- Department of Medicine, UNC Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Sunita J Ferns
- Department of Pediatrics, University of Florida at Jacksonville, 841 Prudential Drive, Jacksonville, FL, 32207, USA.
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10
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Awad K, Weiss R, Yunus A, Bittrick JM, Nekkanti R, Houmsse M, Okabe T, Adamson T, Miller C, Alawwa AK. BioMonitor 2 in-office setting insertion safety and feasibility evaluation with device functionality assessment: results from the prospective cohort BioInsight study. BMC Cardiovasc Disord 2020; 20:171. [PMID: 32293279 PMCID: PMC7161128 DOI: 10.1186/s12872-020-01439-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insertable cardiac monitors are utilized for the diagnosis of arrhythmias and traditionally have been inserted within hospitals. Recent code updates allow for reimbursement of office-based insertions; however, there is limited information regarding the resources and processes required to support in-office insertions. We sought to determine the safety and feasibility of in-office insertion of the BioMonitor 2 and better understand in-office procedures, including patient selection, pre-insertion protocols, resource availability, and staff support. METHODS Patients meeting an indication for a rhythm monitor were prospectively enrolled into this single-arm, non-randomized trial. All patients underwent insertion in an office setting. Two follow-up visits at days 7 and 90 were required. Information on adverse events, device performance, office site preparations, and resource utilization were collected. RESULTS Eighty-two patients were enrolled at six sites. Insertion was successful in all 77 patients with an attempt. Oral anticoagulation was stopped in 20.8% of patients and continued through insertion in 23.4%, while prophylactic antibiotics were infrequently utilized (37.7% of study participants). On average, the procedure required a surgeon plus two support staff and 35 min in an office room to complete the 8.4 min insertion procedure. The mean R-wave amplitude was 0.77 mV at insertion and 0.67 mV at 90-days with low noise burden (2.7%). There were no procedure related complications. Two adverse events were reported (event rate 2.7% [95% CI 0.3, 9.5%]). CONCLUSIONS In-office insertion of the BioMonitor 2 is safe and feasible. Devices performed well with high R-wave amplitudes and low noise burden. These results further support shifting cardiac monitor insertions to office-based locations. TRIAL REGISTRATION clinicaltrials.gov, NCT02756338. Registered 29 April 2016.
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Affiliation(s)
- Khaled Awad
- Mercy Clinic Heart and Vascular at Mercy Heart Hospital, St. Louis, MO, USA.
| | - Raul Weiss
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Asim Yunus
- Michigan CardioVascular Institute, Saginaw, MI, USA
| | | | - Rajasekhar Nekkanti
- The Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Mahmoud Houmsse
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Toshimasa Okabe
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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11
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Mariani JA, Weerasooriya R, van den Brink O, Mohamed U, Gould PA, Pathak RK, Lin T, Conradie A, Illes P, Pavia S, Rajamani K, Lovibond S, Matthews I, DiFiore D, Arumugam D, Schrader J, Lau DH. Miniaturized implantable cardiac monitor with a long sensing vector (BIOMONITOR III): Insertion procedure assessment, sensing performance, and home monitoring transmission success. J Electrocardiol 2020; 60:118-125. [PMID: 32361086 DOI: 10.1016/j.jelectrocard.2020.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Implantable Cardiac Monitors (ICMs) are used for long-term monitoring of arrhythmias. BIOMONITOR III is a novel ICM with a miniaturized profile, long sensing vector due to a flexible antenna, simplified implantation with a dedicated insertion tool for pocket formation and ICM placement in a single step, and daily automatic Home Monitoring (HM) function. METHODS In 47 patients undergoing BIOMONITOR III insertion for any ICM indication, 16 investigators at 10 Australian sites assessed handling characteristics of the insertion tool, R-wave amplitudes, noise burden, P-wave visibility, and HM transmission success. Patients were followed for 1 month. RESULTS All 47 attempted insertions were successful. Median time from skin incision to removal of the insertion tool after ICM insertion was 39 s (IQR 19-65) and to wound closure and cleaning was 4.7 min (IQR 3.5-7.8). All aspects of the insertion tool were rated as "good" or "excellent" in ≥97.9% and "fair" in ≤2.1% of patients, except for "force needed for tunnelling" (91.5% good/excellent, 8.5% fair). Based on HM data, R-waves in the first month were stable at 0.70 ± 0.37 mV. Median noise burden (disabling automatic rhythm evaluation) was 0.19% (IQR 0.00-0.93), equivalent to 2.7 min (IQR 0.0-13.4) per day. In HM-transmitted ECG strips with regular sinus rhythm, P-waves were visible in 89 ± 24% of heart cycles. Patient-individual automatic Home Monitoring transmission success was 98.0% ± 5.5%. CONCLUSIONS The novel ICM performed well in all aspects studied, including fast insertion, reliable R-wave sensing, good P-wave visibility, and highly successful HM transmissions.
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Affiliation(s)
- Justin A Mariani
- The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - Rukshen Weerasooriya
- University of Western Australia, Department of Medicine, Crawley, WA 6000, Australia.
| | - Olivier van den Brink
- The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - Uwais Mohamed
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Paul A Gould
- The University of Queensland, and Department of Cardiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
| | - Rajeev K Pathak
- Australian National University and The Canberra Hospital, Yamba Dr, Canberra, ACT 2605, Australia.
| | - Tina Lin
- GenesisCare Victoria, 5/126 Wellington Pde, East Melbourne, VIC 3002, Australia.
| | - Andre Conradie
- GenesisCare, Friendly Society Private Hospital, 19-23 Bingera Street, Bundaberg, QLD 4670, Australia.
| | - Peter Illes
- Sydney Adventist Hospital, 185 Fox Valley Road, Wahroonga, NSW 2076, Australia
| | - Stephen Pavia
- GenesisCare, The Wesley Hospital, 30 Chasely St, Auchenflower, QLD 4066, Australia.
| | - Kushwin Rajamani
- University of Western Australia, Department of Medicine, Crawley, WA 6000, Australia
| | - Sam Lovibond
- The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Ian Matthews
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - David DiFiore
- GenesisCare, Friendly Society Private Hospital, 19-23 Bingera Street, Bundaberg, QLD 4670, Australia.
| | - Deepak Arumugam
- GenesisCare, The Wesley Hospital, 30 Chasely St, Auchenflower, QLD 4066, Australia.
| | - Jürgen Schrader
- Biotronik SE & Co. KG, Woermannkehre 1, 12359 Berlin, Germany.
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
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12
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Technological Advances in Arrhythmia Management Applied to Adults With Congenital Heart Disease. Can J Cardiol 2019; 35:1708-1722. [DOI: 10.1016/j.cjca.2019.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 11/21/2022] Open
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13
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Barbone AS, Meftah M, Markiewicz K, Dellimore K. Beyond wearables and implantables: a scoping review of insertable medical devices. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab4b32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Lim WY, Papageorgiou N, Sukumar SM, Alexiou S, Srinivasan NT, Monkhouse C, Daw H, Caldeira H, Harvie H, Kuriakose J, Baca M, Ahsan SY, Chow AW, Hunter RJ, Finlay M, Lambiase PD, Schilling RJ, Earley MJ, Providencia R. A nurse-led implantable loop recorder service is safe and cost effective. J Cardiovasc Electrophysiol 2019; 30:2900-2906. [PMID: 31578806 DOI: 10.1111/jce.14206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse-delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost-effectiveness of the introduction of this nurse-delivered ILR service with contemporaneous physician-led procedures. METHODS Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed. RESULTS A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician-implants and two in nurse-implants (P = .3). Procedural time for physician-implants (13.4 ± 8.0 minutes) and nurse-implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician-implants against £279.95 with nurse-implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse-delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse-delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures. CONCLUSION ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings.
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Affiliation(s)
- Wei Yao Lim
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Nikolaos Papageorgiou
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Shivasankar M Sukumar
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sophia Alexiou
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Neil T Srinivasan
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Christopher Monkhouse
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Holly Daw
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helder Caldeira
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helen Harvie
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Jincymol Kuriakose
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Marco Baca
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Syed Y Ahsan
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Anthony W Chow
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College of London, London, United Kingdom
| | - Richard J Schilling
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rui Providencia
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.,Institute of Health Informatics, University College of London, London, United Kingdom
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15
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Hasnie AA, Hasnie AA, Assaly RA. The Case of the Migrating Loop Recorder. JACC Case Rep 2019; 1:156-160. [PMID: 34316774 PMCID: PMC8301509 DOI: 10.1016/j.jaccas.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022]
Abstract
The role of ambulatory electrocardiographic monitoring has changed considerably in recent years with the increased use of implantable loop recorders with their shrinking size. With an excellent safety profile from previous studies, their use is generally seen as a low-risk procedure. Despite this, unexpected complications can occur, including unexpected migration. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Ali A. Hasnie
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
- Address for correspondence: Dr. Ali A. Hasnie, Department of Internal Medicine, College of Medicine and Life Sciences, University of Toledo, 3000 Arlington Avenue, MS# 1150, Toledo, Ohio 43614.
| | - Ammar A. Hasnie
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Ragheb A. Assaly
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
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16
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Piorkowski C, Busch M, Nölker G, Schmitt J, Roithinger FX, Young G, Táborský M, Herrmann G, Schmitz D. Clinical evaluation of a small implantable cardiac monitor with a long sensing vector. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1038-1046. [PMID: 31119745 PMCID: PMC6851891 DOI: 10.1111/pace.13728] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/06/2019] [Accepted: 05/20/2019] [Indexed: 02/03/2023]
Abstract
Introduction We conducted this study to show the safety and efficacy of a new implantable cardiac monitor (ICM), the BioMonitor 2 (Biotronik SE & Co. KG; Berlin, Germany), and to describe the arrhythmia detection performance. Methods The BioMonitor 2 has an extended sensing vector and is implanted close to the heart. It can transmit up to six subcutaneous electrocardiogram strips by Home Monitoring each day. We enrolled 92 patients with a standard device indication for an ICM in a single‐arm, multicenter prospective trial. Patients were followed for 3 months, and 48‐h Holter recordings were used to evaluate the arrhythmia detection performance. Results One patient withdrew consent and in one patient, the implantation failed. Two study device‐related serious adverse events were reported, satisfying the primary safety hypothesis. Implantations took 7.4 ± 4.4 min from skin cut to suture. At 1 week, the R‐wave amplitude was 0.75 ± 0.53 mV. In the 82 patients with completed Holter recordings, all patients with arrhythmias were correctly identified. False positive detections of arrhythmia were mostly irregular rhythms wrongly detected as atrial fibrillation (episode‐based positive predictive value 72.5%). Daily Home Monitoring transmission was 94.9% successful. Conclusion Safety and efficacy of the new device has been demonstrated. The detected R‐wave amplitudes are large, leading to a low level of inappropriate detections due to over‐ or undersensing.
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Affiliation(s)
| | - Mathias Busch
- Department of Internal Medicine B, Greifswald University Hospital, Greifswald, Germany
| | - Georg Nölker
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jörn Schmitt
- Department of Cardiology, University Hospital Giessen, Giessen, Germany
| | | | - Glenn Young
- Department of Cardiology, St. Andrew's Hospital, Adelaide, South Australia, Australia
| | - Miloš Táborský
- Department of Internal Medicine-Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Gundula Herrmann
- Center of Clinical Research, Biotronik SE & Co. KG, Berlin, Germany
| | - Dietmar Schmitz
- Clinic for Cardiology and Angiology, St. Elisabeth Hospital Essen, Essen, Germany
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17
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Sanders P, Piorkowski C, Kragten JA, Goode GK, Raj SR, Dinh T, Sohail MR, Anand R, Moya-Mitjans A, Franco N, Stromberg K, Rogers JD. Safety of in-hospital insertable cardiac monitor procedures performed outside the traditional settings: results from the Reveal LINQ in-office 2 international study. BMC Cardiovasc Disord 2019; 19:132. [PMID: 31151383 PMCID: PMC6545016 DOI: 10.1186/s12872-019-1106-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 05/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background Historically, the majority of insertable cardiac monitor (ICM) procedures were performed in the cardiac catheterization (cath) lab, electrophysiology (EP) lab, or operating room (OR). The miniaturization of ICMs allows the procedure to be relocated within the hospital without compromising patient safety. We sought to estimate the rate of untoward events associated with procedures performed within the hospital but outside the traditional settings and to characterize resource utilization, procedure time intervals, and physician experience. Methods The Reveal LINQ in-Office 2 (RIO 2) International study was a single arm, multicenter, prospective study. Patients indicated for an ICM and willing to undergo device insertion outside the cath/EP lab or OR were eligible and followed for 90 days after insertion. Results A total of 191 patients (45.5% female aged 63.8 ± 26.9 years) underwent successful Reveal LINQ ICM insertion at 17 centers in Europe, Canada and Australia. The median total visit duration was 106 min (interquartile range [IQR]: 55–61). Patient preparation and patient education accounted for 10 min (IQR: 5–20) and 10 min (IQR: 8–15) of total visit duration, respectively. Preparation and education occurred in the procedure room for 90.6 and 60.2% of patients, respectively. There were no untoward events (0.0, 95% CI: 0.0–2.1%) though four patients presented with procedure-related adverse events that did not require invasive intervention. Physicians rated procedure location as convenient or very convenient. Conclusions The Reveal LINQ™ ICM insertion can be safely and efficiently performed in the hospital outside the cath/EP lab or OR. Trial registration ClinicalTrials.gov identifier NCT02412488; registered on April 9, 2015. Electronic supplementary material The online version of this article (10.1186/s12872-019-1106-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
| | | | | | - Grahame K Goode
- Blackpool, Fylde and Wyre Hospitals, NHS Foundation, Blackpool, UK
| | - Satish R Raj
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Trang Dinh
- Maastricht University Medical Center, Maastricht, Netherlands
| | - M Rizwan Sohail
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Rishi Anand
- Holy Cross Hospital, Fort Lauderdale, FL, USA
| | | | - Noreli Franco
- Cardiac Rhythm and Heart Failure, Medtronic, Inc, Mounds View, MN, USA
| | - Kurt Stromberg
- Cardiac Rhythm and Heart Failure, Medtronic, Inc, Mounds View, MN, USA
| | - John D Rogers
- Scripps Prebys Cardiovascular Institute, La Jolla, CA, USA
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18
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Zhao SX, Ziegler PD, Crawford MH, Kwong C, Koehler JL, Passman RS. Evaluation of a clinical score for predicting atrial fibrillation in cryptogenic stroke patients with insertable cardiac monitors: results from the CRYSTAL AF study. Ther Adv Neurol Disord 2019; 12:1756286419842698. [PMID: 31007721 PMCID: PMC6460885 DOI: 10.1177/1756286419842698] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The HAVOC score was previously developed to predict the risk of atrial fibrillation (AF) after cryptogenic stroke (CS) or transient ischemic attack (TIA). The purpose of this study was to apply the HAVOC score to patients who received insertable cardiac monitors (ICMs) in the CRYSTAL AF study. Methods All patients from the CRYSTAL AF study who received an ICM were included. HAVOC score (one point each for peripheral vascular disease and obesity with body mass index >30, two points each for hypertension, age ⩾ 75, valvular heart disease, and coronary artery disease, 4 points for congestive heart failure) was computed for all patients. The primary endpoint was AF detection by 12 months of ICM monitoring. Results A total of 214 patients who received ICM were included. AF was detected in 40 patients while the remaining 174 patients were AF negative. The HAVOC score was significantly higher among patients with AF [median 3.0 with interquartile range (IQR) 2-4] than those without AF [median 2.0 (IQR 0-3)], p = 0.01. AF increased significantly across the three HAVOC score groups: 11% in Group A (score 0-1), 18% in Group B (score 2-3), and 32 % in Group C (score ⩾ 4) with p = 0.02. Conclusions The HAVOC score was shown in this post hoc analysis of CRYSTAL AF to successfully stratify AF risk post CS or TIA. The 11% AF rate in the lowest HAVOC score group highlights the significance of nontraditional contributors to AF and ischemic stroke.
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Affiliation(s)
- Susan X Zhao
- Division of Cardiology, Santa Clara Valley Medical Center, 751 S. Bascom Avenue, Suite # 340, San Jose, CA 95128, USA
| | | | - Michael H Crawford
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rod S Passman
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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19
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Ratajczak-Tretel B, Lambert AT, Johansen H, Halvorsen B, Bjerkeli V, Russell D, Sandset EC, Ihle-Hansen H, Eriksen E, Næss H, Novotny V, Khanevski AN, Truelsen TC, Idicula T, Ægidius KL, Tobro H, Krogseth SB, Ihle-Hansen H, Hagberg G, Kruuse C, Arntzen K, Bakkejord GK, Villseth M, Nakstad I, Eldøen G, Shafiq R, Gulsvik A, Kurz M, Rezai M, Sømark J, Tingvoll SH, Jonassen C, Ingebrigtsen S, Steffensen LH, Kremer C, Atar D, Aamodt AH. Atrial fibrillation in cryptogenic stroke and transient ischaemic attack - The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design. Eur Stroke J 2019; 4:172-180. [PMID: 31259265 DOI: 10.1177/2396987319837089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose Paroxysmal atrial fibrillation is often suspected as a probable cause of cryptogenic stroke. Continuous long-term ECG monitoring using insertable cardiac monitors is a clinically effective technique to screen for atrial fibrillation and superior to conventional follow-up in cryptogenic stroke. However, more studies are needed to identify factors which can help selecting patients with the highest possibility of detecting atrial fibrillation with prolonged rhythm monitoring. The clinical relevance of short-term atrial fibrillation, the need for medical intervention and the evaluation as to whether intervention results in improved clinical outcomes should be assessed. Method The Nordic Atrial Fibrillation and Stroke Study is an international, multicentre, prospective, observational trial evaluating the occurrence of occult atrial fibrillation in cryptogenic stroke and transient ischaemic attack. Patients with cryptogenic stroke or transient ischaemic attack from the Nordic countries are included and will have the Reveal LINQ® Insertable cardiac monitor system implanted for 12 months for atrial fibrillation detection. Biomarkers which can be used as predictors for atrial fibrillation and may identify patients, who could derive the most clinical benefit from the detection of atrial fibrillation by prolonged monitoring, are being studied. Conclusion The primary endpoint is atrial fibrillation burden within 12 months of continuous rhythm monitoring. Secondary endpoints are atrial fibrillation burden within six months, levels of biomarkers predicting atrial fibrillation, CHA2DS2-VASc score, incidence of recurrent stroke or transient ischaemic attack, use of anticoagulation and antiarrhythmic drugs, and quality of life measurements. The clinical follow-up period is 12 months. The study started in 2017 and the completion is expected at the end of 2020.
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Affiliation(s)
- Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Eriksen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Vojtech Novotny
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Thomas C Truelsen
- Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Titto Idicula
- Department of Neurology, St. Olav University Hospital, Trondheim, Norway
| | - Karen L Ægidius
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Håkon Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway
| | - Siv B Krogseth
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - Guri Hagberg
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - Christina Kruuse
- Department of Neurology, Herlev Gentofte Hospital, Copenhagen, Denmark
| | | | | | - Maja Villseth
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ingvild Nakstad
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Raheel Shafiq
- Department of Neurology, Molde Hospital, Molde, Norway
| | - Anne Gulsvik
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Martin Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Mehdi Rezai
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Jesper Sømark
- Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway
| | | | - Christine Jonassen
- Center of Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway.,Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | | | | | - Christine Kremer
- Department of Neurology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology B, Oslo University Hospital, Ullevål, Oslo, Norway
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20
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Beinart SC, Natale A, Verma A, Amin A, Kasner S, Diener HC, Del Greco M, Wilkoff BL, Pouliot E, Franco N, Mittal S. Real-world comparison of in-hospital Reveal LINQ insertable cardiac monitor insertion inside and outside of the cardiac catheterization or electrophysiology laboratory. Am Heart J 2019; 207:76-82. [PMID: 30487072 DOI: 10.1016/j.ahj.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/04/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Traditionally, insertable cardiac monitor (ICM) procedures have been performed in the cardiac catheterization (CATH) or electrophysiology (EP) laboratory. The introduction of the miniaturized Reveal LINQ ICM has led to simplified and less invasive procedures, affording hospitals flexibility in planning where these procedures occur without compromising patient safety or outcomes. METHODS The present analysis of the ongoing, prospective, observational, multicenter Reveal LINQ Registry sought to provide real-world feasibility and safety data regarding the ICM procedure performed in the CATH/EP lab or operating room and to compare it with insertions performed outside of these traditional hospital settings. Patients included had at least a 30-day period after the procedure to account for any adverse events. RESULTS We analyzed 1222 patients (58.1% male, age 61.0 ± 17.1 years) enrolled at 18 centers in the US, 17 centers in Middle East/Asia, and 15 centers in Europe. Patients were categorized into 2 cohorts according to the location of the procedure: in-lab (CATH lab, EP lab, or operating room) (n = 820, 67.1%) and out-of-lab (n = 402, 32.9%). Several differences were observed regarding baseline and procedure characteristics. However, no significant differences in the occurrence of procedure-related adverse events (AEs) were found; of 19 ICM/procedure-related AEs reported in 17 patients (1.4%), 11 occurred in the in-lab group (1.3%) and 6 in the out-of-lab group (1.5%) (P = .80). CONCLUSIONS This real-world analysis demonstrates the feasibility of performing Reveal LINQ ICM insertion procedures outside of the traditional hospital settings without increasing the risk of infection or other adverse events.
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Affiliation(s)
- Sean C Beinart
- Center for Cardiac and Vascular Research, Washington Adventist Hospital, 15225 Shady Grove Rd Ste 201, Rockville, MD.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH 35, Suite 720, Austin, TX.
| | - Atul Verma
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, Ontario, Canada.
| | - Alpesh Amin
- Department of Medicine, University of California,1001 Health Sciences Rd, Irvine, CA.
| | - Scott Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA.
| | - Hans-Cristoph Diener
- Department of Neurology and Stroke Center, University Hospital Essen, Hufelandstraße 55, Essen, Germany.
| | | | - Bruce L Wilkoff
- Cardiac Pacing and Tachyarrhythmia Devices at Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH.
| | - Erika Pouliot
- CRHF Clinical, Statistics, Medtronic, 8200 Coral Sea St. Mounds View, MN.
| | - Noreli Franco
- CRHF Clinical, Medtronic, 8200 Coral Sea St. Mounds View, MN.
| | - Suneet Mittal
- Electrophysiology Laboratory, The Valley Hospital Health System, One Linwood Avenue, Paramus, NJ.
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21
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Padmanabhan D, Kancharla K, El-Harasis MA, Isath A, Makkar N, Noseworthy PA, Friedman PA, Cha YM, Kapa S. Diagnostic and therapeutic value of implantable loop recorder: A tertiary care center experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:38-45. [DOI: 10.1111/pace.13533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/12/2023]
Affiliation(s)
| | - Krishna Kancharla
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
| | | | - Ameesh Isath
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
| | - Nayani Makkar
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
| | | | - Paul A. Friedman
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
| | - Suraj Kapa
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
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22
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Kohno R, Nantsupawat T, Benditt DG. Trends in Subcutaneous Cardiac Monitoring Technology. J Innov Card Rhythm Manag 2018; 9:3247-3255. [PMID: 32494499 PMCID: PMC7252872 DOI: 10.19102/icrm.2018.090703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/02/2018] [Indexed: 02/07/2023] Open
Abstract
Ambulatory cardiac monitoring is a rapidly expanding field and one that is likely to progress beyond electrocardiographic (ECG) and blood pressure recordings. To date, the primary cardiac monitoring focus has been ambulatory ECG (AECG) monitoring. In this setting, AECG monitoring has become a diagnostic tool used daily by physicians of many specialties. In this regard, both wearable and subcutaneous ECG monitoring technologies are now widely available, with the appropriate choice for a given patient being best determined by the frequency with which the patient’s symptom recurrences are expected. In other words, the less frequent the symptomatic events, then the longer the monitoring duration requirement should be. However, multiple factors other than the technology used impact success. For example, wearable AECG systems are only capable of monitoring patients for a period of a few days to several weeks due to limited battery longevity, patient intolerance to cutaneous ECG electrodes, the cumbersome nature of the device, or a combination of these factors. Current-generation insertable cardiac monitors (ICMs), on the other hand, offer three years of monitoring and infrequent skin irritation. Additionally, automatic remote download, a valuable feature in many cases, is only offered by certain wearable technologies, but is an option in all currently available ICMs. This report focuses on the current status of subcutaneous ICMs and their indications and limitations. The goal is to highlight the variety of utility of current ICM technologies and to provide insight into potential future subcutaneous ICM applications.
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Affiliation(s)
- Ritsuko Kohno
- Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Teerapat Nantsupawat
- Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - David G Benditt
- Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
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23
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Steffel J, Wright DJ, Schäfer H, Rashid-Fadel T, Lewalter T. Insertion of miniaturized cardiac monitors outside the catheter operating room: experience and practical advice. Europace 2018; 19:1624-1629. [PMID: 28340242 PMCID: PMC5834127 DOI: 10.1093/europace/euw304] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/30/2016] [Indexed: 12/12/2022] Open
Abstract
Minor surgical procedures are increasingly being performed as outpatient procedures in settings outside hospital operating rooms (ORs). In electrophysiology, the recent miniaturization of insertable cardiac monitors (ICMs) has enabled the routine insertion of the device as a minimally invasive procedure without the need of a catheter OR. However, a shift to office-based environments for minor surgical procedures is associated with some concerns, particularly with respect to patient- and procedure-related safety in the new setting. In the present document, the authors provide practical advice on facilities, practices, and adaptations necessary when performing ICM insertions in office settings, based on available recommendations as well as their own experience with the use of the novel Reveal LINQ ICM. The main differences from in-hospital implant settings are simplified requirements of room, equipment, and insertion procedures, while ensuring and maintaining an adequate, sterile environment. Patient selection is important: certain groups of patients are recommended to be treated in the catheter OR (e.g. those at increased risk for bleeding or very frail elderly individuals). Insertion in alternative positions, as is sometimes performed for cosmetic reasons, should be referred to dedicated hospitals. Quality assurance and internal quality control are critical in the new procedural landscape, and it is important not to trivialize minor surgical procedures. Operators' sharing of experiences and lessons learned, e.g. in the form of registries, should be encouraged.
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Affiliation(s)
- Jan Steffel
- Division of Electrophysiology and Devices, University Heart Center Zurich, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
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24
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Preminger MW, Musat DL, Sichrovsky T, Bhatt AG, Mittal S. Migration of an implantable loop recorder into the pleural space. HeartRhythm Case Rep 2018; 3:539-541. [PMID: 29387547 PMCID: PMC5778094 DOI: 10.1016/j.hrcr.2017.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mark W Preminger
- The Valley Hospital Health System, Ridgewood, New Jersey, and New York, New York
| | - Dan L Musat
- The Valley Hospital Health System, Ridgewood, New Jersey, and New York, New York
| | - Tina Sichrovsky
- The Valley Hospital Health System, Ridgewood, New Jersey, and New York, New York
| | - Advay G Bhatt
- The Valley Hospital Health System, Ridgewood, New Jersey, and New York, New York
| | - Suneet Mittal
- The Valley Hospital Health System, Ridgewood, New Jersey, and New York, New York
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25
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Wiles BM, Illingworth CA, Couzins ML, Roberts PR, Harden SP. A tertiary centre experience of thoracic CT and cardiac MRI scanning in the presence of a reveal LINQ insertable cardiac monitoring system: a case series review of artefact, patient safety and data preservation. THE BRITISH JOURNAL OF RADIOLOGY 2018; 91:20170615. [PMID: 29322834 DOI: 10.1259/bjr.20170615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE At our tertiary cardiothoracic centre, cardiac MRI and thoracic CT scans are performed in patients with implanted LINQ devices. The degree of foreign body artefact associated with the LINQ device, and its clinical importance, has not previously been assessed. A case series review was therefore performed with a simultaneous review of patient safety and data loss events, secondary to the MRI environment. METHODS A local database search identified LINQ device patients who underwent thoracic CT or cardiac MRI scans between March 2014 and December 2016. Images were reviewed by two radiologists, recording the presence of subcutaneous and intrathoracic artefact, and its clinical significance. Furthermore a specialist in cardiac rhythm management reviewed all LINQ data downloads undertaken before and after MRI scanning, and a search of the trust incident reporting system was performed. RESULTS Minor subcutaneous artefact was present on all scans. Intrathoracic artefact was observed in 25.6% of thoracic CT scans and 33.3% of cardiac MRIs; however no clinically significant artefact was observed. Device downloads were only performed by 53.8% of patients prior to their MRI scan and 56.5% after their MRI scan. No adverse patient safety or data loss events were noted. CONCLUSION The LINQ device does not produce clinically significant artefact, even when artefact extends into the intrathoracic space, which occurs in a third of MRIs and a quarter of CTs. MRI scanning of the LINQ device is safe with no evidence of inappropriate data loss. Advances in knowledge: This is the first published case series of CT and MRI scanning in LINQ patients and the first performed quantification of artefact related to the LINQ device.
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Affiliation(s)
- Benedict M Wiles
- 1 Department of Cardiac Rhythm Management Research, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Caroline A Illingworth
- 2 Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Michael Lg Couzins
- 2 Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Paul R Roberts
- 1 Department of Cardiac Rhythm Management Research, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Stephen P Harden
- 2 Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust , Southampton , UK
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Roberts PR, Zachariah D, Morgan JM, Yue AM, Greenwood EF, Phillips PC, Kalra PA, Green D, Lewis RJ, Kalra PR. Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study. PLoS One 2017; 12:e0188713. [PMID: 29240772 PMCID: PMC5730159 DOI: 10.1371/journal.pone.0188713] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/22/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION It has been suggested that sudden cardiac death (SCD) contributes around 50% of cardiovascular and 27% of all-cause mortality in hemodialysis patients. The true burden of arrhythmias and arrhythmic deaths in this population, however, remains poorly characterised. Cardio Renal Arrhythmia Study in Hemodialysis (CRASH-ILR) is a prospective, implantable loop recorder single centre study of 30 established hemodialysis patients and one of the first to provide long-term ambulatory ECG monitoring. METHODS 30 patients (60% male) aged 68±12 years receiving hemodialysis for 45±40 months with varied etiology (diabetes 37%, hypertension 23%) and left ventricular ejection fraction (LVEF) 55±8% received a Reveal XT implantable loop recorder (Medtronic, USA) between August 2011 and October 2014. ECG data from loop recorders were transmitted at each hemodialysis session using a remote monitoring system. Primary outcome was SCD or implantation of a (tachy or bradyarrhythmia controlling) device and secondary outcome, the development of arrhythmia necessitating medical intervention. RESULTS During 379,512 hours of continuous ECG monitoring (mean 12,648±9,024 hours/patient), there were 8 deaths-2 SCD and 6 due to generalised deterioration/sepsis. 5 (20%) patients had a primary outcome event (2 SCD, 3 pacemaker implantations for bradyarrhythmia). 10 (33%) patients reached an arrhythmic primary or secondary end point. Median event free survival for any arrhythmia was 2.6 years (95% confidence intervals 1.6-3.6 years). CONCLUSIONS The findings confirm the high mortality rate seen in hemodialysis populations and contrary to initial expectations, bradyarrhythmias emerged as a common and potentially significant arrhythmic event.
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Affiliation(s)
- Paul R. Roberts
- Southampton University Hospitals, Southampton, United Kingdom
| | | | - John M. Morgan
- Southampton University Hospitals, Southampton, United Kingdom
| | - Arthur M. Yue
- Southampton University Hospitals, Southampton, United Kingdom
| | | | | | | | | | | | - Paul R. Kalra
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
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Kipp R, Young N, Barnett A, Kopp D, Leal MA, Eckhardt LL, Teelin T, Hoffmayer KS, Wright J, Field M. Injectable loop recorder implantation in an ambulatory setting by advanced practice providers: Analysis of outcomes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:982-985. [DOI: 10.1111/pace.13155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/01/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ryan Kipp
- Division of Cardiology; University of Wisconsin; Madison WI
- Division of Cardiology; William S Middleton Veteran Affairs Hospital; Madison WI
| | - Natasha Young
- Division of Cardiology; University of Wisconsin; Madison WI
| | - Anne Barnett
- Division of Cardiology; University of Wisconsin; Madison WI
| | - Douglas Kopp
- Division of Cardiology; University of Wisconsin; Madison WI
| | - Miguel A. Leal
- Division of Cardiology; University of Wisconsin; Madison WI
- Division of Cardiology; William S Middleton Veteran Affairs Hospital; Madison WI
| | | | - Thomas Teelin
- Division of Cardiology; University of Wisconsin; Madison WI
| | - Kurt S. Hoffmayer
- Division of Cardiology; University of California San Diego; San Diego CA
| | | | - Michael Field
- Division of Cardiology; University of Wisconsin; Madison WI
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Ciconte G, Giacopelli D, Pappone C. The Role of Implantable Cardiac Monitors in Atrial Fibrillation Management. J Atr Fibrillation 2017; 10:1590. [PMID: 29250232 DOI: 10.4022/jafib.1590] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/19/2017] [Accepted: 08/26/2017] [Indexed: 11/10/2022]
Abstract
Continuous heart rhythm monitoring using implantable cardiac monitors (ICMs) for atrial fibrillation (AF) management is steadily increasing in current clinical practice, even in the absence of an established indication provided by international guidelines. The increasing use of such devices is mainly associated with recent technological improvements including miniaturization, easier implant procedures, and remote monitoring, all of which make this strategy continuously more appealing and promising. For these and other reasons, ICMs have been proven to be a safe and highly effective tool for detecting AF episodes. However, ICMs are not the best option for every patient, as limitations exist. Therefore, it is imperative to weigh the possible benefits against the potential limitations of using these devices when deciding individualized patient care.
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Affiliation(s)
- Giuseppe Ciconte
- Department of Arrhythmology, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (MI), Italy
| | | | - Carlo Pappone
- Department of Arrhythmology, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (MI), Italy
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29
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Complications after implantation of a new-generation insertable cardiac monitor: Results from the LOOP study. Int J Cardiol 2017; 241:229-234. [DOI: 10.1016/j.ijcard.2017.03.144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 01/09/2023]
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30
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Di Odoardo LA, Ambrosini F, Giavarini A, Vicenzi M, Venturini F, Lombardi F. Reveal LINQTM experience out of the electrophysiology lab. J Cardiovasc Med (Hagerstown) 2017; 18:550-552. [DOI: 10.2459/jcm.0000000000000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Lee JJ, Weitz D, Anand R. Holding Area LINQ Trial (HALT). Indian Pacing Electrophysiol J 2017; 17:163-166. [PMID: 29231819 PMCID: PMC5784691 DOI: 10.1016/j.ipej.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/14/2017] [Accepted: 06/18/2017] [Indexed: 11/24/2022] Open
Abstract
Background Recent studies have shown that insertable cardiac monitors (ICMs) can be implanted out of the traditional hospital setting and efforts are being made to explore the feasibility of implanting these devices in a specific standardized location other than the operating room or a cardiac catherization/electrophysiology lab. Methods This was a prospective, non-randomized, single center post-market clinical trial designed to occur in the holding area of a hospital operating room or cardiac catheterization/electrophysiology laboratory. The Medtronic Reveal LINQ ICM was implanted and patients were followed for 90 days post implant. This study was designed to observe any procedure related adverse events stemming from the holding area implantation. Results Twenty patients were implanted at our hospital in a holding room not traditionally associated with the electrophysiology/cardiac/operatory labs. One patient was lost to the 90-day follow up. In one case, ICM implantation led to diagnosis requiring removal of ICM before the 90 day follow up and insertion of a biventricular implantable cardioverter defibrillator (ICD). In the remaining 18 patients, there were no serious complications such as minor skin infections, systemic infections or procedure-related adverse events requiring device explant. Conclusion When following a standardized protocol with attention to sterile technique, it is feasible to implant ICMs in a holding area with no procedure related adverse events (AE).
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Affiliation(s)
- John J Lee
- University of Miami, Holy Cross Hospital, Fort Lauderdale, FL 33308, United States
| | - Daniel Weitz
- Holy Cross Hospital, Fort Lauderdale, FL 33308, United States
| | - Rishi Anand
- Holy Cross Hospital, Fort Lauderdale, FL 33308, United States.
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Diederichsen SZ, Haugan KJ, Køber L, Højberg S, Brandes A, Kronborg C, Graff C, Holst AG, Nielsen JB, Krieger D, Svendsen JH. Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in individuals at risk (the LOOP study): Rationale and design of a large randomized controlled trial. Am Heart J 2017; 187:122-132. [PMID: 28454796 DOI: 10.1016/j.ahj.2017.02.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/06/2017] [Indexed: 02/05/2023]
Abstract
Atrial fibrillation (AF) increases the rate of stroke 5-fold, and AF-related strokes have a poorer prognosis compared with non-AF-related strokes. Atrial fibrillation and stroke constitute an intensifying challenge, and health care organizations are calling for awareness on the topic. Previous studies have demonstrated that AF is often asymptomatic and consequently undiagnosed. The implantable loop recorder (ILR) allows for continuous, long-term electrocardiographic monitoring with daily transmission of arrhythmia information, potentially leading to improvement in AF detection and stroke prevention. METHODS The LOOP study is an investigator-initiated, randomized controlled trial with 6,000 participants randomized 3:1 to a control group or to receive an ILR with continuous electrocardiographic monitoring. Participants are identified from Danish registries and are eligible for inclusion if 70years or older and previously diagnosed as having at least one of the following conditions: hypertension, diabetes mellitus, heart failure, or previous stroke. Exclusion criteria include history of AF and current oral anticoagulation treatment. When an AF episode lasting ≥6minutes is detected, oral anticoagulation will be initiated according to guidelines. Expected follow-up is 4years. The primary end point is time to stroke or systemic embolism, whereas secondary end points include time to AF diagnosis and death. CONCLUSION The LOOP study will evaluate health benefits and cost-effectiveness of ILR as a screening tool for AF to prevent stroke in patients at risk. Secondary objectives include identification of risk factors for the development of AF and characterization of arrhythmias in the population. The trial holds the potential to influence the future of stroke prevention.
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Affiliation(s)
- Søren Zöga Diederichsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ketil Jørgen Haugan
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Højberg
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Kronborg
- Centre of Health Economics Research (COHERE), Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Anders Gaarsdal Holst
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; The Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark
| | - Jonas Bille Nielsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Derk Krieger
- University Hospital Zurich, Switzerland; Mediclinic City Hospital, Dubai, United Arabic Emirates
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark.
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Conti S, Reiffel JA, Gersh BJ, Kowey PR, Wachter R, Halperin JL, Kaplon RE, Pouliot E, Verma A. Baseline Demographics, Safety, and Patient Acceptance of an Insertable Cardiac Monitor for Atrial Fibrillation Screening: The REVEAL-AF Study. J Atr Fibrillation 2017; 9:1551. [PMID: 29250279 DOI: 10.4022/jafib.1551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/28/2017] [Accepted: 01/29/2017] [Indexed: 11/10/2022]
Abstract
Given the high prevalence and risk of stroke associated with atrial fibrillation (AF), detection strategies have important public health implications. The ongoing prospective, single-arm, open-label, multicenter REVEAL AF trial is evaluating the incidence of previously undetected AF using an insertable cardiac monitor (ICM) in patients without prior AF or device implantation, but who could be at risk for AF due to their demographic characteristics, +/- non-specific but compatible symptoms. Enrollment required an elevated AF risk profile defined as CHADS2≥3 or CHADS2=2 plus one or more of the following: coronary artery disease, renal impairment, sleep apnea or chronic obstructive pulmonary disease. Exclusions included stroke or transient ischemic attack occurring in the previous year. Of 450 subjects screened, 399 underwent a device insertion attempt, and 395 were included in the final analysis (Reveal XT: n=122; Reveal LINQ: n=273; excluded: n=4). Participants were primarily identified by demographic characteristics and the presence of nonspecific symptoms, but without prior documentation of "overt" AF. The most common symptoms were palpitations (51%), dizziness/lightheadedness/pre-syncope (36%), and shortness of breath (36%). Over 100 subjects were enrolled in each pre-defined CHADS2 subgroup (2, 3 and ≥4). AF risk factors not included in the CHADS2 score were well represented (prevalence≥15%). Procedure and/or device related serious adverse events were low, with the miniaturized Reveal LINQ ICM having a more favorable safety profile than the predicate Reveal XT (all: n=13 [3.3%]; LINQ: n=6 [2.2%]; XT: n=7 [5.7%]). These data demonstrate that REVEAL AF was successful in enrolling its target population, high risk patients were willing to undergo ICM monitoring for AF screening, and ICM use in this group is becoming increasingly safe with advancements in technology. A clinically meaningful incidence of device detected AF in this study will inform clinical decisions regarding ICM use for AF screening in patients at risk.
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Affiliation(s)
- Sergio Conti
- Department of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - James A Reiffel
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter R Kowey
- Department of Internal Medicine-Cardiology, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany; German Cardiovascular Research Center (DZHK), Göttingen, Germany
| | - Jonathan L Halperin
- Department of Medicine-Cardiology. Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Rachelle E Kaplon
- Diagnostics, Cardiac Rhythm and Heart Failure, Medtronic, Inc. Mounds View, Minnesota, USA
| | - Erika Pouliot
- Diagnostics, Cardiac Rhythm and Heart Failure, Medtronic, Inc. Mounds View, Minnesota, USA
| | - Atul Verma
- Department of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
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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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D'Souza R, Thomas E, Macicek S, Aziz P, Shivapour JK, Snyder C. P- and R-wave Amplitude Sensed by Reveal LINQ™ Loop Recorder in Pediatric Patients. J Innov Card Rhythm Manag 2017; 8:2584-2588. [PMID: 32477753 PMCID: PMC7252757 DOI: 10.19102/icrm.2017.080102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/30/2017] [Indexed: 11/29/2022] Open
Abstract
Implantable loop recorders are commonly used to sense arrhythmias. The purpose of this study is to assess the P- and R-wave amplitudes at implantation (I) and follow-up (F) following insertion of the Reveal LINQ™ Insertable Cardiac Monitor (Medtronic, Minneapolis, MN) in an institutional review board-approved, multicenter study performed on pediatric patients younger than 18 years old. Collected data included demographics, presence of congenital heart disease (CHD), P- and R-wave-sensed amplitude at I and F, and the method of implant (i.e. mapping or standard.) P waves were manually measured and R-wave sensing was recorded by the device. A total of 87 patients had a Reveal LINQ™ (Medtronic, Minneapolis, MN) device implanted; the mean patient age was 11.8 years (0.5 years to 18 years) with 48% of patients being female and 19% of patients having CHD; mapping was used in 43% of patients. The Reveal LINQ™ (Medtronic, Minneapolis, MN) experienced no change in average sensed R-wave amplitude at either I or F (1.28 mV vs 1.26 mV, p = NS). There was no difference in sensed R-wave amplitude noted with or without mapping used at I (1.29 mV vs 1.26 mV, p = NS) or F (1.48 mV vs 1.18 mV, p = NS). Additionally, no difference could be found in R-wave sensing of patients with CHD or without CHD at I (1.26 mV vs 1.4 mV, p = NS) or F (1.32 mV vs 1.32 mV, p = NS). R-wave sensing trended towards being inversely proportional to patient body surface area (BSA) (p = NS). P waves were detected on 48% of tracings in all patients at I and/or F, irrespective of whether the Reveal LINQ™ (Medtronic, Minneapolis, MN) device was placed with mapping. The R wave was (0.37–3.5 mV) at I and (0.3–3 mV) (p = NS) at F when P waves were detected. From these results, it can be said that the Reveal LINQ™ Insertable Cardiac Monitor (Medtronic, Minneapolis, MN) has an excellent ability to sense R-wave amplitude in pediatric patients. No significant difference in the sensing ability of the device could be identified with respect to the presence of CHD, use of mapping or BSA. P waves tended to be identified when there was a higher baseline R-wave amplitude.
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Affiliation(s)
- Roshan D'Souza
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | - Peter Aziz
- Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Jill K Shivapour
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christopher Snyder
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
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Lortz J, Varnavas V, WEIßENBERGER W, Erbel R, Reinsch N. Maintaining Accurate Long-Term Sensing Ability Despite Significant Size Reduction of Implantable Cardiac Monitors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1344-1350. [PMID: 27862030 DOI: 10.1111/pace.12977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/02/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Reveal LINQ™ implantable cardiac monitor (ICM; Medtronic, Minneapolis, MN, USA) is obviously smaller than its precursor (the Reveal XT™), but little is known about its long-term safety. Here, we investigated the long-term R-wave sensing reliability of the Reveal LINQ™ ICM. METHODS We analyzed the sensing quality of the Reveal LINQ™ ICM over time between March 2014 and January 2015. RESULTS A total of 30 patients underwent Reveal LINQ™ implantation. The main reason for implantation was unexplained syncope (60%). We evaluated a total of 305.8 patient-months (median, 10.7 months) of R-wave sensing quality. A comparison of baseline and follow-up R-wave sensing values revealed no difference (0.401 mV ± 0.244 mV vs 0.447 mV ± 0.323 mV; P = 0.225). CONCLUSIONS The consistent detection of events is an important safety feature of an ICM and linked to secure R-wave sensing. Despite the noticeable size reduction, the Reveal LINQ™ ICM retains reliable sensing quality over time.
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Affiliation(s)
- Julia Lortz
- Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Varnavas Varnavas
- Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Wilko WEIßENBERGER
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Nico Reinsch
- Division of Electrophysiology, Department of Internal Medicine I and Cardiology, Alfried Krupp Hospital Essen, Essen, Germany
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[Implantable loop recorder in atrial fibrillation and after catheter ablation]. Herzschrittmacherther Elektrophysiol 2016; 27:355-359. [PMID: 27832334 DOI: 10.1007/s00399-016-0471-1] [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: 08/16/2016] [Accepted: 08/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Implantable loop recorders (ILR) are an established diagnostic method for detection of cardiac arrhythmias including atrial fibrillation. OBJECTIVE The aim of this work is to provide an overview of available data and indications of ILR in atrial fibrillation, especially after catheter ablation, in order to illustrate practice-oriented recommendations. MATERIALS AND METHODS We conducted a selective PubMed literature search. RESULTS AND DISCUSSION ILR can record asymptomatic/rare atrial fibrillation episodes and prevent thromboembolic events by allowing timely initiation of oral anticoagulation. They can be used to assess therapeutic success after percutaneous or surgical ablation, if despite increased thromboembolic risk, no oral anticoagulation is desired. ILR equipped with remote monitoring function and special P wave detection algorithms may improve diagnostic confidence.
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Wong GR, Lau DH, Middeldorp ME, Harrington JA, Stolcman S, Wilson L, Twomey DJ, Kumar S, Munawar DA, Khokhar KB, Mahajan R, Sanders P. Feasibility and safety of Reveal LINQ insertion in a sterile procedure room versus electrophysiology laboratory. Int J Cardiol 2016; 223:13-17. [PMID: 27525370 DOI: 10.1016/j.ijcard.2016.08.113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/05/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insertable cardiac monitors (ICMs) are increasingly utilized for diagnosis of unexplained syncope and arrhythmia monitoring. The Reveal LINQ is a novel miniaturized ICM with improved algorithms. The feasibility and safety of insertion outside the traditional electrophysiology laboratory is unknown. Here we compare outcomes of Reveal LINQ insertion in different environments. METHODS We report on a prospective, single-centre, non-randomized, observational experience of consecutive Reveal LINQ implantation in the electrophysiology laboratory or a procedure room between October 2013 and October 2015. RESULTS Of 178 consecutive patients who underwent LINQ device insertion, 80 were implanted in the electrophysiology laboratory and 98 in a procedure room. There were no significant differences in baseline patient characteristics. All implants were performed in the recommended manufacturer method with the exception of 1 which required suture closure. Only a minority received peri-procedural antibiotics with a greater number in the electrophysiology laboratory group (11 [14%] versus 1 [1%], p=0.007). Overall, there were 3 (1.7%) complications with no significant difference between the electrophysiology laboratory and the procedure room groups (2 [3%] versus 1 [1%], p=0.45). There was 1 superficial infection in the procedure room group and 1 superficial infection with device extrusion and 1 traumatic extrusion in the electrophysiology laboratory group. Procedure room implantation subjectively improved laboratory efficiency and patient flow. CONCLUSION Reveal LINQ insertion can be safely performed outside of the cardiac laboratory provided a sterile technique is followed by the operator using manufacturer recommendations for insertion. These findings have significant resource implications for hospitals undertaking such procedures.
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Affiliation(s)
- Geoffrey R Wong
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Judith A Harrington
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Simon Stolcman
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Lauren Wilson
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Darragh J Twomey
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Sharath Kumar
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Dian A Munawar
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Kashif B Khokhar
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia.
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BEINART SEANC, NATALE ANDREA, VERMA ATUL, AMIN ALPESH, KASNER SCOTT, DIENER HANS, POULIOT ERIKA, FRANCO NORELI, MITTAL SUNEET. Real‐World Use of Prophylactic Antibiotics in Insertable Cardiac Monitor Procedures. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:837-42. [DOI: 10.1111/pace.12886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- SEAN C. BEINART
- Center for Cardiac and Vascular Research Washington Adventist Hospital Rockville Maryland
| | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute St. David's Medical Center Austin Texas
| | - ATUL VERMA
- Southlake Regional Health Centre Newmarket Ontario Canada
| | - ALPESH AMIN
- Department of Medicine University of California Irvine California
| | - SCOTT KASNER
- Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | | | | | | | - SUNEET MITTAL
- Electrophysiology Laboratory The Valley Hospital Health System Ridgewood New Jersey
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Sugumar H, Tung MK, Lane C, Sterns LD, Novak PG, Leather R. Ejectable loop recorders? Heart Rhythm 2016; 13:2105. [PMID: 27261071 DOI: 10.1016/j.hrthm.2016.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Hariharan Sugumar
- Royal Jubilee Hospital and Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada.
| | - Matthew K Tung
- Royal Jubilee Hospital and Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - Christopher Lane
- Royal Jubilee Hospital and Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - Laurence D Sterns
- Royal Jubilee Hospital and Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - Paul G Novak
- Royal Jubilee Hospital and Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - Richard Leather
- Royal Jubilee Hospital and Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
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