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A comparison of Atrial Fibrillation Detection Strategies After Ischemic Stroke-A Retrospective Study. Curr Probl Cardiol 2023; 48:101515. [PMID: 36435267 DOI: 10.1016/j.cpcardiol.2022.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
Objective of this retrospective study was to determine if long-term continuous cardiac monitoring with Implantable loop recorder (ILR) in patients with Cryptogenic strokes or TIA is superior at detecting Atrial Fibrillation (AF) than 30-day Event Monitor (EM) and 48-hour Holter Monitor (HM). Furthermore, we aimed to deduce if uncovering AF leads to lower risk of future ischemic strokes, or reduction in mortality. In 20%-30% cases, the cause of stroke remained unexplained after diagnostic workup which has led to coining of the term, Cryptogenic Stroke (CS). Undiagnosed AF is a prime suspect in CS, but guidelines do not recommend initiation of anticoagulation unless AF has formally been detected. IRB approved retrospective study included patients with at least 1 episode of ischemic stroke or TIA without identifiable cause and was monitored with either HM, EM or ILR to diagnose any undiscovered AF. All patients (n = 531) had at least 1 year, and up to 3 years, of follow-up after device placement. Chi-Squared analysis and Multivariable logistic regression demonstrated no statistically significant difference among 3 devices for detection of AF within 1 month of index stroke but a significant difference in AF detection was observed at 6, 12 and 24 months. Cox proportional hazard model showed device type had no significant impact on secondary outcomes: Subsequent ischemic stroke or TIA, Initiation of anticoagulation, Mortality and Incidence of major bleeding. Despite the superiority of AF detection by ILR, it is not superior to HM or EM in lowering the risk of subsequent stroke or TIA, or in reducing mortality.
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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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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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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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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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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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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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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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