Insertable cardiac monitors: current indications and devices

Sakhi, Rafi; Theuns, Dominic; Szili-Török, Tamás; Yap, Sing‐Chien

doi:10.1080/17434440.2018.1557046

Cited by 33 publications

(25 citation statements)

References 91 publications

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“…An ICM is a sensitive tool to detect paroxysmal arrhythmias and is particularly useful for establishing a symptom-rhythm correlation. In the general population, there is a clear indication for an ICM in patients with recurrent unexplained syncope [12,15]. Interestingly, the recent ESC guidelines give a class IIa indication (level of evidence C) for an ICM (instead of an ICD) in Brugada patients with recurrent unexplained syncope who are at low risk of SCD [12].…”

Section: Role Of Icm In Brugada Syndromementioning

confidence: 99%

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

et al. 2020

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Introduction: There is limited data on the experience with insertable cardiac monitors (ICMs) in patients with Brugada syndrome. Objective: To evaluate the outcome of ICM in symptomatic patients with Brugada syndrome who are at suspected low risk of sudden cardiac death (SCD). Methods: We conducted a prospective single-center cohort study including all symptomatic patients with Brugada syndrome who received an ICM (Reveal LINQ) between July 2014 and October 2019. The main indication for monitoring was to exclude ventricular arrhythmias as the cause of symptoms and to establish a symptom-rhythm relationship. Results: A total of 20 patients (mean age, 39 ± 12 years; 55% male) received an ICM during the study period. Nine patients (45%) had a history of syncope (presumed nonarrhythmogenic), and 5 patients had a recent syncope (< 6 months). During a median follow-up of 32 months (interquartile range, 11-36 months), 3 patients (15%) experienced an episode of nonsustained ventricular arrhythmia. No patient died suddenly or experienced a sustained ventricular arrhythmia, and no patient had a recurrence of syncope. Overall, 17 patients (85%) experienced symptoms during follow-up, of whom 10 patients had an ICM-detected arrhythmia. In 4 patients (20%), the ICM-detected arrhythmia was an actionable event. ICMguided management included antiarrhythmic drug therapy for symptomatic ectopic beats (n = 3), pulmonary vein isolation, and oral anticoagulation for atrial fibrillation (n = 1), electrophysiological study for risk stratification (n = 1), and pacemaker implantation for atrioventricular block (n = 1). Conclusions: An ICM can be used to exclude ventricular arrhythmias in symptomatic patients with Brugada syndrome at low risk of SCD. Furthermore, an ICM-detected arrhythmia changed clinical management in 20% of patients.

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Section: Role Of Icm In Brugada Syndromementioning

confidence: 99%

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

et al. 2020

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“…The indications for an ICM has expanded over the years, and its use is currently not only limited to patients with recurrent unexplained syncope [1, 8]. Other important indications include the detection of subclinical AF, risk stratification in patients with inheritable heart disease by the detection of VT, and establishing a symptom-rhythm correlation in symptomatic patients [9]. In patients with HCM who are at low risk for SCD according to the HCM Risk-SCD score, the current ESC guidelines recommends that an ICM should be considered in patients with recurrent unexplained syncope and may be considered in those with unexplained palpitations [1, 2].…”

Section: Discussionmentioning

confidence: 99%

“…One patient of the ICM group had a VT episode which was automatically detected (32 beats, 200 bpm). The characteristics of documented VT episodes were similar between groups with regard to the median number of documented beats (5 [IQR, 5-7] vs. 6 [IQR,[4][5][6][7][8][9][10][11], for the ICM group and the control group, respectively, p = 1.00) and median rate (150 bpm [IQR, 145-155 bpm] vs. 136 bpm [IQR, 125-168 bpm], for the ICM group and the control group, respectively, p = 0.21).…”

Section: Secondary Endpointmentioning

confidence: 99%

Incremental Value of an Insertable Cardiac Monitor in Patients with Hypertrophic Cardiomyopathy with Low or Intermediate Risk for Sudden Cardiac Death

Sakhi¹,

Huurman²,

Theuns³

et al. 2021

Cardiology

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Aims: The aim of the present study was to compare the rate of actionable arrhythmic events between patients with hypertrophic cardiomyopathy (HCM) who are monitored with an insertable cardiac monitor (ICM) or Holter monitoring. Methods: We studied 50 patients (mean age 52 years, 72% men) with HCM at low or intermediate risk for sudden cardiac death (SCD), of whom 25 patients received an ICM between November 2014 and February 2019. We retrospectively identified a control group of 25 patients who were matched on age, sex, and HCM Risk-SCD score category. The mean HCM Risk-SCD score was 3.41 ± 1.31 and 3.31 ± 1.43 for the ICM and Holter groups, respectively. The primary endpoint was an actionable event which was defined as an arrhythmic event resulting in a change in patient management. The secondary endpoint was the occurrence of ventricular tachycardia (VT). Results: The cumulative actionable event rate at 30 months was higher in the ICM group (51 vs. 27%, log-rank p value <0.01). De novo atrial fibrillation requiring oral anticoagulation occurred only in the ICM group (n = 3). Overall, 4 implantable cardioverter-defibrillators were implanted for primary prevention (n = 2 in each group). The cumulative rate of VT episodes at 30 months was similar between groups (23% [ICM group] vs. 42% [Holter group], log-rank p value = 0.71). Furthermore, the characteristics of VT were similar between groups with regard to the number of beats and rate. Conclusions: In adults with HCM, an ICM will detect more arrhythmic events requiring an intervention than a conventional Holter strategy. In contrast, the diagnostic yield of detecting VT seems similar for both groups.

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“…Newer devices have dedicated algorithms resulting in increased interest in their use for AF detection, especially after cryptogenic stroke. Several approved ILR devices are available, 22‐24 and several studies have been performed to evaluate the diagnostic accuracy of these devices 25‐29 . Since ILRs are invasive and costly, some functions may shift to mHealth.…”

Section: Mhealth Technologiesmentioning

confidence: 99%

2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Varma

Cygankiewicz

Turakhia

et al. 2021

Journal of Arrhythmia

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This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health (“mHealth”) technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self‐management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

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Insertable cardiac monitors: current indications and devices

Cited by 33 publications

References 91 publications

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

Outcome of Insertable Cardiac Monitors in Symptomatic Patients with Brugada Syndrome at Low Risk of Sudden Cardiac Death

Incremental Value of an Insertable Cardiac Monitor in Patients with Hypertrophic Cardiomyopathy with Low or Intermediate Risk for Sudden Cardiac Death

2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

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