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Bučić D, Hrabak-Paar M. Multimodality imaging in patients with implantable loop recorders: Tips and tricks. Hellenic J Cardiol 2024; 77:93-105. [PMID: 38096953 DOI: 10.1016/j.hjc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/09/2023] [Indexed: 12/26/2023] Open
Abstract
An implantable loop recorder (ILR) is a leadless rectangular device used for prolonged electrocardiographic monitoring for up to 3 years. This miniaturized device, inserted subcutaneously, allows clinicians to investigate possible cardiac rhythm disturbances in patients suffering from recurrent unexplained syncope. As the age of the population increases rapidly and the number of ILR patients amplifies, the clinical significance of ILRs is undeniable. Although radioopaque and easily seen on plain chest radiographs and other imaging modalities, ILRs may represent a challenge for clinicians and radiologists to recognize their classic appearance and differentiate them from numerous other cardiac devices. This article aims to summarize current literature on ILRs, their basic function, types, and indications for implantation, but most of all, it aims to familiarize clinicians and radiologists with common imaging features of these devices, safety issues, and artifact-reducing methods. Specifically, this review discusses the typical appearance of ILRs on major diagnostic imaging modalities, including chest X-ray, mammography, ultrasonography, computed tomography, and magnetic resonance imaging (MRI). Furthermore, optimization strategies to mitigate image artifacts and safety issues regarding MRI are discussed.
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Affiliation(s)
- Dinea Bučić
- School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Maja Hrabak-Paar
- School of Medicine, University of Zagreb, Zagreb, Croatia; Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Zagreb, Croatia.
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Lau DH, Pierre B, Cabanas P, Martens E, Bisignani G, Hofer D, Berruezo A, Eschalier R, Mansourati J, Gaspar T, Sanfins VM, Erglis A, Hain A, Papaioannou G, Cuneo A, Tscholl V, Schrader J, Deneke T. Diagnostic yield of an insertable cardiac monitor in a large patient population. Heart Rhythm O2 2023; 4:97-102. [PMID: 36873314 PMCID: PMC9975005 DOI: 10.1016/j.hroo.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are increasingly used for cardiac rhythm diagnosis with expanding indications. Little has been reported about their use and efficacy. Objective The study sought to evaluate the clinical utility of a novel ICM (Biotronik BIOMONITOR III) including the time to diagnosis in unselected patients with different ICM indications. Methods Patients from 2 prospective clinical studies were included to determine the diagnostic yield of the ICM. The primary endpoint was time to clinical diagnosis per implant indication or to the first change in atrial fibrillation (AF) therapy. Results A total of 632 patients were included with a mean follow-up of 233 ± 168 days. Of 384 patients with (pre)syncope, 34.2% had a diagnosis at 1 year. The most frequent therapy was permanent pacemaker implantation. Of 133 patients with cryptogenic stroke, 16.6% had an AF diagnosis at 1 year, resulting in oral anticoagulation. Of 49 patients with an indication for AF monitoring, 41.0% had a relevant change in AF therapy based on ICM data at 1 year. Of 66 patients with other indications, 35.4% received a rhythm diagnosis at 1 year. Moreover, 6.5% of the cohort had additional diagnoses: 26 of 384 patients with syncope, 8 of 133 patients with cryptogenic stroke, and 7 of 49 patients with AF monitoring. Conclusion In a large unselected patient population with heterogeneous ICM indications, the primary endpoint of rhythm diagnosis was achieved in ∼1 in 4, and additional clinically relevant findings was achieved in 6.5% of patients at short-term follow-up.
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Affiliation(s)
- Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, Australia
| | - Bertrand Pierre
- Department of Cardiology, Tours University Hospital, Chambray-lès-Tours, France
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Berruezo
- Department of Cardiology, Teknon Heart Institute, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Thomas Gaspar
- Heart Center, University of Dresden, Dresden, Germany
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
| | - Andrejs Erglis
- Department of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | | | - Alessandro Cuneo
- Department of Cardiology, Krankenhaus Maria-Hilf Stadtlohn, Stadtlohn, Germany
| | - Verena Tscholl
- Department of Cardiology, Charité Universitaetsmedizin, Campus Mitte, Berlin, Germany
| | - Jürgen Schrader
- Department of Cardiology, Biotronik SE & Co.KG, Berlin, Germany
| | - Thomas Deneke
- Department of Cardiology, Rhön Clinic Campus Bad Neustadt, Saale, Germany
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The BIOMONITOR III Injectable Cardiac Monitor: Clinical Experience with a Novel Injectable Cardiac Monitor. J Clin Med 2022; 11:jcm11061634. [PMID: 35329960 PMCID: PMC8954265 DOI: 10.3390/jcm11061634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Injectable cardiac monitors (ICMs) are leadless subcutaneous devices for long-term monitoring of arrhythmias. The BIOTRONIK BIOMONITOR III is a novel ICM with a miniaturized profile, long sensing vector, and simplified implantation technique. Methods: R-wave amplitude was recorded immediately after implantation, the day after implantation, and after 3 months. Follow-up was scheduled after 3 months or after an event. All data from the ICM were retrieved. The anatomical position of the ICM was determined post-implantation and after 3 months. A patient questionnaire was conducted after 3 months. Results: In 36 patients (mean age 67 ± 13 years; 40% male) an ICM was inserted. Six patients were not included in the final analysis. The median time from skin cut to wound closure was 6 [IQR 5–7] minutes. Mean R-wave amplitude increased over time (0.73 ± 32 mV vs. 0.78 ± 0.38 mV vs. 0.81 ± 0.39 mV; p = ns). Three months after implantation, the ICM was in an anatomically stable position. In 14 (47%) patients, true episodes were detected. False arrhythmia alerts were detected in 13 (43%) patients. The total number of false detections was low, and the patient satisfaction rate was high. Conclusion: Implantation of the novel BIOMONITOR III is fast and uncomplicated; its sensing characteristics are excellent and improve over time, and patient satisfaction is high.
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Deneke T, Cabanas P, Hofer D, Gaspar T, Pierre B, Bisignani G, Pathak RK, Sanfins VM, Martens E, Mansourati J, Berruezo-Sanchez A, Wiemer M, Hain A, Pezawas T, Wenzel B, Lau D. New Generation Miniaturized Insertable Cardiac Monitor with a Long Sensing Vector: Insertion Procedure, Sensing Performance, and Home Monitoring Transmission Success in a Real-World Population. Heart Rhythm O2 2022; 3:152-159. [PMID: 35496450 PMCID: PMC9043386 DOI: 10.1016/j.hroo.2022.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Thomas Deneke
- Rhön Clinic Campus Bad Neustadt, Bad Neustadt a. d. Saale, Germany
- Address reprint requests and correspondence: Prof Dr Thomas Deneke, RHÖN-KLINIKUM Campus Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany.
| | | | | | - Thomas Gaspar
- Heart Center, University of Dresden, Dresden, Germany
| | | | | | | | | | - Eimo Martens
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | | | | | | | | | | | - Dennis Lau
- Royal Adelaide Hospital, Adelaide, Australia
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Ahn JH, Ryu H, Oh I, Cho Y, Lee JH. Analysis of the determining factors of detectable P-wave and amplitude of QRS complex sensed by implantable loop recorder. J Arrhythm 2021; 37:1069-1076. [PMID: 34386134 PMCID: PMC8339105 DOI: 10.1002/joa3.12582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/11/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Determining factors for sufficient QRS amplitude and discernible P-wave sensing in implantable loop recorder (ILR) are unknown. We aimed to investigate determining factors and ILR implantation angle that may improve QRS complex and P-wave sensing in ILR. METHODS We retrospectively reviewed 220 patients who underwent ILR implantation or follow-up analysis. Patient demographic, clinical, echocardiography, electrocardiography, heart angle, and ILR angle data were collected as predictor variables. Associations between ILR QRS amplitude/P-wave detectability and each predictor variable were investigated. RESULTS Univariate linear regression showed that ILR QRS amplitude was significantly associated with age, height, ILR angle, and QRS amplitudes of 12-lead electrocardiogram (ECG) (lead I, II, aVR [inverted aVR], aVF, V1-V6) and Holter ECG (lead V3, V5). Among discrete variables, only left ventricular hypertrophy (LVH) affected ILR QRS amplitude (P = .016). A multivariate linear regression analysis revealed that ILR angle (β = -0.008, P < .001), lead aVR amplitude (β = 0.469, P = .003), Holter lead V5 amplitude (β = 0.116, P = .049), Age (β = -0.005, P = .014), and LVH (β = 0.213, P = .031) were independent determinants of ILR QRS amplitude. Logistic regression revealed that heart angle significantly affected ILR P-wave detectability (β = 0.12, P = .008). Multiple logistic regression revealed that heart angle (β = 0.121, P = .013) and lead V1 amplitude (β = 28.1, P = .034) were independent determinants of ILR P-wave detectability. CONCLUSION ILR insertion angle, lead aVR QRS amplitude, Holter lead V5 QRS amplitude, age, and LVH are determinants of ILR QRS amplitude. Heart angle and lead V1 P-wave amplitude of 12-lead ECG are determinants of ILR P-wave detectability.
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Affiliation(s)
- Jang Ho Ahn
- College of MedicineSeoul National UniversitySeoulSouth Korea
| | - Hyunho Ryu
- College of MedicineSeoul National UniversitySeoulSouth Korea
| | - Il‐Young Oh
- College of MedicineSeoul National UniversitySeoulSouth Korea
- Division of CardiologyDepartment of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Youngjin Cho
- Division of CardiologyDepartment of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Ji Hyun Lee
- Division of CardiologyDepartment of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
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Mariani JA, Weerasooriya R, van den Brink O, Mohamed U, Gould PA, Pathak RK, Lin T, Conradie A, Illes P, Pavia S, Rajamani K, Lovibond S, Matthews I, DiFiore D, Arumugam D, Schrader J, Lau DH. Miniaturized implantable cardiac monitor with a long sensing vector (BIOMONITOR III): Insertion procedure assessment, sensing performance, and home monitoring transmission success. J Electrocardiol 2020; 60:118-125. [PMID: 32361086 DOI: 10.1016/j.jelectrocard.2020.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Implantable Cardiac Monitors (ICMs) are used for long-term monitoring of arrhythmias. BIOMONITOR III is a novel ICM with a miniaturized profile, long sensing vector due to a flexible antenna, simplified implantation with a dedicated insertion tool for pocket formation and ICM placement in a single step, and daily automatic Home Monitoring (HM) function. METHODS In 47 patients undergoing BIOMONITOR III insertion for any ICM indication, 16 investigators at 10 Australian sites assessed handling characteristics of the insertion tool, R-wave amplitudes, noise burden, P-wave visibility, and HM transmission success. Patients were followed for 1 month. RESULTS All 47 attempted insertions were successful. Median time from skin incision to removal of the insertion tool after ICM insertion was 39 s (IQR 19-65) and to wound closure and cleaning was 4.7 min (IQR 3.5-7.8). All aspects of the insertion tool were rated as "good" or "excellent" in ≥97.9% and "fair" in ≤2.1% of patients, except for "force needed for tunnelling" (91.5% good/excellent, 8.5% fair). Based on HM data, R-waves in the first month were stable at 0.70 ± 0.37 mV. Median noise burden (disabling automatic rhythm evaluation) was 0.19% (IQR 0.00-0.93), equivalent to 2.7 min (IQR 0.0-13.4) per day. In HM-transmitted ECG strips with regular sinus rhythm, P-waves were visible in 89 ± 24% of heart cycles. Patient-individual automatic Home Monitoring transmission success was 98.0% ± 5.5%. CONCLUSIONS The novel ICM performed well in all aspects studied, including fast insertion, reliable R-wave sensing, good P-wave visibility, and highly successful HM transmissions.
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Affiliation(s)
- Justin A Mariani
- The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - Rukshen Weerasooriya
- University of Western Australia, Department of Medicine, Crawley, WA 6000, Australia.
| | - Olivier van den Brink
- The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - Uwais Mohamed
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Paul A Gould
- The University of Queensland, and Department of Cardiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
| | - Rajeev K Pathak
- Australian National University and The Canberra Hospital, Yamba Dr, Canberra, ACT 2605, Australia.
| | - Tina Lin
- GenesisCare Victoria, 5/126 Wellington Pde, East Melbourne, VIC 3002, Australia.
| | - Andre Conradie
- GenesisCare, Friendly Society Private Hospital, 19-23 Bingera Street, Bundaberg, QLD 4670, Australia.
| | - Peter Illes
- Sydney Adventist Hospital, 185 Fox Valley Road, Wahroonga, NSW 2076, Australia
| | - Stephen Pavia
- GenesisCare, The Wesley Hospital, 30 Chasely St, Auchenflower, QLD 4066, Australia.
| | - Kushwin Rajamani
- University of Western Australia, Department of Medicine, Crawley, WA 6000, Australia
| | - Sam Lovibond
- The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Ian Matthews
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - David DiFiore
- GenesisCare, Friendly Society Private Hospital, 19-23 Bingera Street, Bundaberg, QLD 4670, Australia.
| | - Deepak Arumugam
- GenesisCare, The Wesley Hospital, 30 Chasely St, Auchenflower, QLD 4066, Australia.
| | - Jürgen Schrader
- Biotronik SE & Co. KG, Woermannkehre 1, 12359 Berlin, Germany.
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
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Piorkowski C, Busch M, Nölker G, Schmitt J, Roithinger FX, Young G, Táborský M, Herrmann G, Schmitz D. Clinical evaluation of a small implantable cardiac monitor with a long sensing vector. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1038-1046. [PMID: 31119745 PMCID: PMC6851891 DOI: 10.1111/pace.13728] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/06/2019] [Accepted: 05/20/2019] [Indexed: 02/03/2023]
Abstract
Introduction We conducted this study to show the safety and efficacy of a new implantable cardiac monitor (ICM), the BioMonitor 2 (Biotronik SE & Co. KG; Berlin, Germany), and to describe the arrhythmia detection performance. Methods The BioMonitor 2 has an extended sensing vector and is implanted close to the heart. It can transmit up to six subcutaneous electrocardiogram strips by Home Monitoring each day. We enrolled 92 patients with a standard device indication for an ICM in a single‐arm, multicenter prospective trial. Patients were followed for 3 months, and 48‐h Holter recordings were used to evaluate the arrhythmia detection performance. Results One patient withdrew consent and in one patient, the implantation failed. Two study device‐related serious adverse events were reported, satisfying the primary safety hypothesis. Implantations took 7.4 ± 4.4 min from skin cut to suture. At 1 week, the R‐wave amplitude was 0.75 ± 0.53 mV. In the 82 patients with completed Holter recordings, all patients with arrhythmias were correctly identified. False positive detections of arrhythmia were mostly irregular rhythms wrongly detected as atrial fibrillation (episode‐based positive predictive value 72.5%). Daily Home Monitoring transmission was 94.9% successful. Conclusion Safety and efficacy of the new device has been demonstrated. The detected R‐wave amplitudes are large, leading to a low level of inappropriate detections due to over‐ or undersensing.
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Affiliation(s)
| | - Mathias Busch
- Department of Internal Medicine B, Greifswald University Hospital, Greifswald, Germany
| | - Georg Nölker
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jörn Schmitt
- Department of Cardiology, University Hospital Giessen, Giessen, Germany
| | | | - Glenn Young
- Department of Cardiology, St. Andrew's Hospital, Adelaide, South Australia, Australia
| | - Miloš Táborský
- Department of Internal Medicine-Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Gundula Herrmann
- Center of Clinical Research, Biotronik SE & Co. KG, Berlin, Germany
| | - Dietmar Schmitz
- Clinic for Cardiology and Angiology, St. Elisabeth Hospital Essen, Essen, Germany
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