Implantable loop recorder in clinical practice

Bisignani, Antonio; Bonis, Silvana De; Mancuso, Luigi; Ceravolo, Gianluca; Bisignani, Giovanni

doi:10.1002/joa3.12142

Cited by 75 publications

(76 citation statements)

References 62 publications

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“…The development of ILR enabled a continuous long-term (up to three years) recording and automatic identification of arrhythmias, which results in a dramatic increase in its diagnostic yield. ILRs are composed of a miniaturized battery and sensor electrode, which are implanted within minutes subcutaneously in the chest above the heart, enabling long-term high quality cardiac rhythm monitoring [ 83 , 84 ]. Once an arrhythmia is detected, it is recorded by the ILR, which then sends an automatic alarm to the patient’s clinic via internet connection, in order to facilitate diagnosis and the selection of additional appropriate therapy.…”

Section: Implantable Long-term Electrocardiographic Monitoring Devmentioning

confidence: 99%

Cardiac Implantable Electronic Miniaturized and Micro Devices

Rav

Soifer²,

Hasin

2020

Micromachines

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Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities (‘arrhythmias’), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert for early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients’ life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and the termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and the survival of HF patients. Traditionally, these devices are implanted via the venous system (‘endovascular’) using conductors (‘endovascular leads/electrodes’) that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection resulting from the lifelong exposure of these leads to bacteria within the venous system. One of the important cardiac innovations in the last decade was the development of a leadless PPM functioning without venous leads, thus circumventing most endovascular PPM-related problems. Leadless PPM’s consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, directly implanted into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM’s sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices that are designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development. Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities (‘arrhythmias’), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients’ life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and survival of HF patients. Traditionally, these devices are implanted via the venous system (‘endovascular’) using conductors (‘endovascular leads/electrodes’) that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection that result from the lifelong exposure of these leads to bacteria within the venous system. The development of a leadless PPM functioning without venous leads was one of the important cardiac innovations in the last decade, thus circumventing most endovascular PPM-related problems. Leadless PPM’s consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, implanted directly into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM’s sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development.

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Section: Implantable Long-term Electrocardiographic Monitoring Devmentioning

confidence: 99%

Cardiac Implantable Electronic Miniaturized and Micro Devices

Rav

Soifer²,

Hasin

2020

Micromachines

View full text Add to dashboard Cite

show abstract

“…The false positive arrhythmia alerts which drive the inaccurate diagnostic performance of ICM are mostly related to inadequate R‑wave sensing. As the ICM electrodes are positioned at some distance from the cardiac muscle, there is greater scope for interference and artefacts [ 6 , 7 , 47 ]. Typically, an R‑wave sensing value of at least 0.3 mV is targeted [ 21 ].…”

Section: Insertable Cardiac Monitorsmentioning

confidence: 99%

Over- and undersensing—pitfalls of arrhythmia detection with implantable devices and wearables

Sperzel

Hamm

Hain

2020

Herzschr Elektrophys

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“…Persons with autonomic neuropathy are at high risk of having lethal arrythmias ("death in the bed syndrome") (11). If no obvious cardiac causes, orthostasis or postprandial hypotension are present, an elderly person with syncope should be considered for a subcutaneous implantable loop recorder (12). Ambulatory recorders rarely are useful as usually the next syncopal episode occurs months after the previous one.…”

Section: Syncopementioning

confidence: 99%

The Magic of Spells

Morley

2020

The Journal of nutrition, health and aging

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Implantable loop recorder in clinical practice

Cited by 75 publications

References 62 publications

Cardiac Implantable Electronic Miniaturized and Micro Devices

Cardiac Implantable Electronic Miniaturized and Micro Devices

Over- and undersensing—pitfalls of arrhythmia detection with implantable devices and wearables

The Magic of Spells

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