Evolution of Implantable Cardiac Monitors: A Comparison of Reveal XT and LINQ Patient Selection, Arrhythmia Detection, and Clinical Outcomes

Abstract

Implantable cardiac monitors (ICMs) are useful for long-term arrhythmia monitoring in patients with unexplained symptoms. Temporal trends in the use of ICMs in routine clinical practice, along with the clinical indications for use, arrhythmia detection accuracy, and association with clinical outcomes have not been described. We identified all patients who underwent ICM implantation at the Minneapolis Heart Institutet between January 1, 2011, and February 26, 2016, using diagnosis codes for device implantation. From 2011 to 2016, a total of 603 patients with ICM devices were identified and 570 patients were analyzed including 139 Medtronic Reveal XT between 2011 and 2014, and 431 Reveal LINQ between 2014 and 2016. The 3-fold increase in ICM implants was primarily tied to the rise of LINQ monitoring for cryptogenic stroke patients (36% for LINQ vs. 5% for XT; P , 0.001). LINQ patients had fewer complications than XT patients (2.3% vs. 7.9%; P , 0.001). Atrial fibrillation detection accuracy was similar between the devices. Of patients with ICM implants, 30% had at least 1 intervention. The intervention rate was similar between the 2 models (P ¼ 0.40) as was the time to intervention (P ¼ 0.81). Since the release of the LINQ device, there has been an increase in the use of ICM implants among patients with cryptogenic stroke. LINQ ICM monitors have fewer complications post-implant. Only 5.6% of all syncope and cryptogenic stroke patients had a diagnosis within 1 month of implant. Despite potential improvements in arrhythmia detection accuracy, clinic work-flow is influenced by a higher volume of patient activated events that require interpretation.

Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke: a systematic review and economic evaluation

“…Clinical expert opinion and evidence from a mixed population suggest that the Reveal LINQ has better specificity than the XT (see Chapter 3), is easier to implant and leads to fewer complications due to its size, and that AF detection accuracy between the devices is similar. 28 Medtronic highlighted that the size of Reveal LINQ differentiates it from other devices and means that a smaller incision in the skin is required (< 1 cm). Clinical experts at the NICE scoping workshop reported that the procedure can be done by health-care professionals other than cardiologists (e.g.…”

“…Clinical expert opinion and evidence from a mixed population suggest that the Reveal LINQ may have better sensitivity and specificity for detecting AF than the Reveal XT and is likely to lead to fewer complications owing to its size, but there are no head-to-head clinical trials to confirm these findings in a CS population. 28 In addition, no clinical or DTA data suitable for inclusion were identified for the BioMonitor 2-AF or Confirm Rx devices, despite widening the eligibility criteria to include low-quality non-comparative observational studies. Data for the BioMonitor 2-AF or Confirm Rx devices were limited to mixed population diagnostic accuracy and single-arm observational studies submitted by the companies.…”