P5648Efficiency and accuracy of arrhythmia detection using implantable cardiac monitor: A prospective multicenter randomized clinical trial comparing Reveal LINQ and Confirm Rx

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Yokokawa ◽  
B Jaffe ◽  
R Ip ◽  
R Azad ◽  
M Castellani ◽  
...  
Keyword(s):  
Heart Rate ◽  
Data Transmission ◽  
Cardiac Arrhythmias ◽  
Randomized Study ◽  
Cryptogenic Stroke ◽  
Data Availability ◽  
P Wave ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

Abstract Background Implantable cardiac monitor (ICM) has been used to detect occult cardiac arrhythmias in a variety of clinical situations. The reliability and accuracy of diagnosing cardiac arrhythmia could impact patient care. However, it is not clear the efficiency and reliability of detecting cardiac arrhythmias between currently available two ICMs. Purpose To compare the efficiency and accuracy of diagnosing cardiac arrhythmias between Reveal LINQ™ and Confirm Rx™. Methods In the prospective multicenter randomized study, a total of 80 patients (age: 61±17 years, men: 41 [51%]) with cryptogenic stroke (n=52) or recurrent unexplained episodes of palpitations (n=3) or syncope (n=25) received an ICM for detection of arrhythmias. Patients were randomized one to one into receiving either Reveal LINQ™ or Confirm Rx™. Arrhythmic events are defined as pauses of ≥3.0 seconds, bradycardia with heart rate of ≤40 bpm, tachycardia with heart rate of ≥150 bpm, and atrial fibrillation (AF). The time of detected arrhythmic events and patient activated events to the time of data availability on respective website site for analysis were compared between the two ICM. All of the arrhythmia events were adjudicated by two cardiologists to assess the accuracy. Results A total of 680 arrhythmic events including 352 AFs, 109 bradycardias, 167 tachycardias and 52 pauses were transmitted over a mean follow-up of 4.2±2.5 months. The mean time to data transmission was significantly faster in Confirm Rx™ than in Reveal LINQ™ (24±103 vs 475±426 min, P<0.0001). One-hundred fifty-nine of 352 AF events (45%) and 237 of 328 non-AF events (72%) were accurately detected by ICMs (P<0.0001). Twenty-eight of 51 AF events (55%) were detected accurately by Reveal LINQ™ and 131 of 301 AF events (44%) were accurately detected by Confirm Rx™ (P=0.13). The reason for inaccurate AF detection was frequent ectopic beats (n=134), P-wave oversensing (n=15), T-wave oversensing (n=8), both P- and T-waves oversensing (n=18) and sinus tachycardia with R-wave undersensing (n=18). Conclusions Data transmission of arrhythmic events using Confirm Rx™ is significantly faster than Reveal LINQ™. The accuracy of AF detection with current algorithms in both ICM remains suboptimal. More patients and longer follow-up is required to confirm these findings.

scholarly journals Implantable cardiac monitor after cryptogenic stroke: atrial fibrillation detection and predictors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Ebrille ◽  
C Amellone ◽  
M.T Lucciola ◽  
F Orlando ◽  
M Suppo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Risk Stratification ◽  
Median Time ◽  
Remote Monitoring ◽  
Cryptogenic Stroke ◽  
Screening Process ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

Abstract Objective The main objective of our study was to analyze the incidence and predictors of atrial fibrillation (AF) in patients with cryptogenic stroke (CS) who received an implantable cardiac monitor (ICM) at our Institution. Methods From November 2013 to October 2017, a total of 133 patients who had suffered a CS were implanted with an ICM after a thorough screening process. The median time between the thromboembolic event and ICM implantation was 64 days [IQ range: 16–111]. All implanted patients were followed with remote monitoring until the first detected episode of AF or up to December 2018. Every remote monitoring transmission and related electrograms were analyzed by the dedicated Electrophysiology Nursing team and confirmed by experienced Electrophysiologists. AF was defined by any episode lasting greater than or equal to 2 minutes. Results During a median follow-up of 14.8 months [IQ range: 3.0–31.2], AF was detected in 65 out of 133 patients (48.9%). The median time from ICM implantation and AF detection was 3.5 months [IQ range: 0.9–6.7]. The prevalence of AF was 22.6%, 34.4%, 40.8% and 48.3% at 3, 6, 12 and 24 months respectively. At the multivariate analysis, high premature atrial contractions (PAC) burden and left atrium (LA) dilation were the only independent predictors of AF detection (HR 2.82, 95% CI 1.64–4.83, p&lt;0.001 for PAC; HR 1.75, 95% CI 1.03–2.97, p=0.038 for LA dimension). Patients were dived into categories based on the probability of AF detection (low, intermediate and high risk) and a new risk stratification algorithm was implemented (Figure 1). Conclusion After a thorough screening process, AF detection in patients with CS and ILM was quite high. Having a high PAC burden and LA dilation predicted AF episodes at the multivariate analysis. A new risk stratification algorithm was developed. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract W P194: Improved Efficacy of ICM Detection of Atrial Fibrillation in Cryptogenic Stroke Patients with MRI-Defined Infarcts: Preliminary Results from the SPIDER Registry

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kelley Joseph ◽  
Stephen Wanjiku ◽  
Mohammed Jumaa ◽  
Mark Richards
Keyword(s):  
Atrial Fibrillation ◽  
Detection Rate ◽  
Brain Mri ◽  
Cryptogenic Stroke ◽  
Mri Imaging ◽  
Cardiac Monitor ◽  
The Brain ◽  
Improve Access ◽  
Implantable Cardiac Monitor

Introduction: Recent trials have demonstrated the efficacy of the implantable cardiac monitor (ICM) in detecting atrial fibrillation (AF) in cryptogenic stroke (CS) patients. However, these trials have included patients with TIAs or no CT or MRI imaging of the brain. We hypothesized that the AF detection rate in CS patients would be improved by requiring the presence of an embolic-appearing infarct on MRI. Methods: All CS patients within the Promedica Stroke Network were considered for inclusion in the SPIDER (Stroke Prevention through the Improved Detection of AF) registry. All patients were monitored by inpatient telemetry for AF for a minimum of 48 hours, and received brain MRI with or without angiography. Patients with no AF, a negative transesophageal echo for ASD/PFO, and an embolic-appearing MRI infarct (wedge infarct, multiple vascular distributions) were offered an ICM (Reveal or Reveal LINQ™) for AF detection (minimum of 10 seconds). Results: 64 patients have been enrolled to date and followed for 223 days. Mean age was 66.9 ± 12.8 years and 40.6% were female with a median NIH stroke score of 5.2 on presentation. AF episodes were detected in 11 patients, resulting in an AF detection rate of 17.2% and a median time to AF detection of 35 days. While both mean follow-up and time to AF detection were comparable to the data from CRYSTAL-AF (6 months, 41 days), AF detection rate was increased nearly two-fold. Conclusions: Here we show that restricting ICM implantation for AF detection in CS patients to those with MRI-defined embolic-appearing infarcts improves efficacy, with an increase of 8.3% in detection at six months, when adjusted for follow-up time. Explanations for this higher detection rate might include a slightly higher age (66.9 vs 61.5 years of age), a more liberal cutoff for AF (10 vs 30 seconds), and, likely, a more highly selected patient population. Such an approach might both improve access to this important technology and help preserve health care resources.

scholarly journals Assessment of Cardiac Arrhythmias at Extreme High Altitude Using an Implantable Cardiac Monitor

Circulation ◽  
2017 ◽  
Vol 135 (8) ◽  
pp. 812-814 ◽  
Author(s):  
Christopher John Boos ◽  
David A. Holdsworth ◽  
David Richard Woods ◽  
John O’Hara ◽  
Naomi Brooks ◽  
...  
Keyword(s):  
High Altitude ◽  
Cardiac Arrhythmias ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

scholarly journals 287TIME TO INITIAL DETECTION OF ATRIAL FIBRILLATION [AF] WITH IMPLANTABLE CARDIAC MONITOR [ICM] IN CRYPTOGENIC STROKE

2016 ◽  
Vol 45 (suppl 2) ◽  
pp. ii1.50-ii12
Author(s):  
Nkechi Uzomefuna ◽  
Frederick Okpoko ◽  
Hafiz Hussein ◽  
David Williams ◽  
Brendan McAdam
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

IMPLANTATION OF CHARDACK-GREATBATCH ADJUSTABLE RATE AND CURRENT PACEMAKER IN A 4-MONTH-OLD INFANT

PEDIATRICS ◽  
1966 ◽  
Vol 37 (2) ◽  
pp. 323-328
Author(s):  
Marie Vitória Martin ◽  
Adauto Barbosa Lime ◽  
Cyro S. Almeida ◽  
Pedro Geretto ◽  
Renato Del Nero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Septal Defect ◽  
P Wave ◽  
Rapid Improvement ◽  
Great Vessels ◽  
Adjustable Rate ◽  
Pace Maker ◽  
Corrected Transposition

The implantation of a definitive pacemaker in a 4-month, 11-day-old infant with congenital heart block, has been described. Following her first syncopal episode, signs of heart failure became increasingly worse and after unsuccessful hospital clinical treatment for one month the Chardack-Greatbatch adjustable rate and current pace maker was implanted, with a heart rate settled at 100, or slightly below the P-wave rate of the baby. There was rapid improvement of the signs of heart failure, with beginning of weight gain and discontinuation of diuretics. She was discharged on the thirteenth postoperative day and the follow-up examination 3 weeks after the operation disclosed a baby with good color and a heart rate of 100, gaining weight, and without signs of heart failure. In spite of these encouraging results, it is realized that a much longer period will be required to establish the success of this treatment. During surgery she was suspected of having a corrected transposition of the great vessels and possibly an associated septal defect. Further investigation of her associated malformation has been deferred to a more suitable opportunity.

Sign in / Sign up

Export Citation Format

Share Document