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Shelke S, Veerubhotla K, Lee Y, Lee CH. Telehealth of cardiac devices for CVD treatment. Biotechnol Bioeng 2024; 121:823-834. [PMID: 38151894 DOI: 10.1002/bit.28637] [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: 10/03/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
This review covers currently available cardiac implantable electronic devices (CIEDs) as well as updated progress in real-time monitoring techniques for CIEDs. A variety of implantable and wearable devices that can diagnose and monitor patients with cardiovascular diseases are summarized, and various working mechanisms and principles of monitoring techniques for Telehealth and mHealth are discussed. In addition, future research directions are presented based on the rapidly evolving research landscape including Artificial Intelligence (AI).
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Affiliation(s)
- Sushil Shelke
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Krishna Veerubhotla
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Yugyung Lee
- Division of Computer Science, School of Science and Engineering, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Chi H Lee
- Division of Pharmacology and Pharmaceutics Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Cossú SF, Kramer J, Maitz T, Kher A, Racharla L. Identification of acute ST-elevation myocardial infarction via remote implantable loop recorder monitor. J Electrocardiol 2023; 81:244-249. [PMID: 37862913 DOI: 10.1016/j.jelectrocard.2023.10.001] [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: 07/08/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
The indications for the use of implantable loop recorders include the evaluation of unexplained palpitations and syncope, embolic stroke of undetermined source, dizziness and lightheadedness presumed to be due to arrhythmogenic etiology, and for atrial fibrillation to guide antiarrhythmic drug therapy or catheter ablation efficacy. Long-term monitoring is especially beneficial if symptoms occur sporadically or are asymptomatic in nature. This is the first case to our knowledge of an acute ST-elevation myocardial infarction which was identified from remote monitoring of an implantable loop recorder through a device clinic.
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Stremmel C, Breitschwerdt R. Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review. JMIR Cardio 2023; 7:e44983. [PMID: 37647103 PMCID: PMC10500361 DOI: 10.2196/44983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. OBJECTIVE After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). METHODS We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. RESULTS Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. CONCLUSIONS Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.
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Sugiura J, Kasama S, Ueda T, Nishida T, Kawata H, Horii M, Ozu N, Kasahara M, Saito Y. Rationale and design of the NEO-NORMAL-AF study examination of the usefulness of implantable loop recorder for arrhythmia detection including atrial fibrillation in heart failure with non-reduced ejection fraction cases: a pilot study. Open Heart 2023; 10:e002193. [PMID: 37507149 PMCID: PMC10387650 DOI: 10.1136/openhrt-2022-002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The incidence of arrhythmia in heart failure with non-reduced ejection fraction (HFnon-rEF) in patients who have a history of hospitalisation is unclear. The aim of this study is to investigate the usefulness of an implantable loop recorder (ILR) for arrhythmia detection including atrial fibrillation (AF) in HFnon-rEF patients after discharge. METHODS AND ANALYSIS This is a multicentre single arm study to evaluate the usefulness of ILR for detecting arrhythmia. The eligible patients are HFnon-rEF patients (left ventricular ejection fraction ≥40%) aged ≥20 years with a history of hospitalisation. The ILR will be implanted for qualified patients, and ECGs will be monitored and recorded for 1 year to check for arrhythmias. The primary endpoint is new-onset 6 min or more persistent AF detected by ILR. Secondary endpoints are 30 s or more persistent supraventricular tachycardia and ventricular tachycardia, 3 s or more persistent pause, bradycardia with 40 beats per minutes or lower heart rate, AF burden, all-cause death, cardiovascular death, hospital readmission due to exacerbation of HF, acute coronary syndrome, ischaemic or haemorrhagic stroke, non-pharmacological therapy such as pacemaker implantation and ablation. CONCLUSIONS This study is expected to provide valuable findings regarding arrhythmia in HFnon-rEF patients, and elucidate a potential new therapeutic approach for HFnon-rEF. TRIAL REGISTRATION NUMBER This trial has been registered in the Japan Registry of Clinical Trials (jRCT) (Trial Registration: jRCTs052210060).
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Affiliation(s)
- Junichi Sugiura
- Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Syu Kasama
- Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Taku Nishida
- Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Kawata
- Cardiovascular Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Manabu Horii
- Cardiovascular Medicine, Nara City Hospital, Nara, Japan
| | - Naoki Ozu
- Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Japan
| | - Masato Kasahara
- Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
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Gorter TM, van Veldhuisen DJ, Mulder BA, Artola Arita VA, van Empel VPM, Manintveld OC, Tieleman RG, Maass AH, Vernooy K, van Gelder IC, Rienstra M. Prevalence and Incidence of Atrial Fibrillation in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: (Additive) Value of Implantable Loop Recorders. J Clin Med 2023; 12:jcm12113682. [PMID: 37297876 DOI: 10.3390/jcm12113682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is common in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and has a negative impact on outcome. Reliable data on prevalence, incidence, and detection of AF from contemporary, prospective HFmrEF/HFpEF studies are scarce. METHODS This was a prespecified sub-analysis from a prospective, multicenter study. Patients with HFmrEF/HFpEF underwent 12-lead electrocardiography (ECG), 24 h Holter monitoring, and received an implantable loop recorder (ILR) at the study start. During the 2 year follow-up, rhythm monitoring was performed via ILR, yearly ECG, and two yearly 24 h Holter monitors. RESULTS A total of 113 patients were included (mean age 73 ± 8 years, 75% HFpEF). At baseline, 70 patients (62%) had a diagnosis of AF: 21 paroxysmal, 18 persistent, and 31 permanent AF. At study start, 45 patients were in AF. Of the 43 patients without a history of AF, 19 developed incident AF during a median follow-up of 23 [15-25] months (44%; incidence rate 27.1 (95% confidence interval 16.3-42.4) per 100 person-years). Thus, after the 2-year follow-up, 89 patients (79%) had a diagnosis of AF. In 11/19 incident AF cases (i.e., 58%), AF was solely detected on the ILR. Yearly 12-lead ECG detected six incident AF cases and four of these cases were also detected on two yearly 24 h Holter monitors. Two incident AF cases were detected on an unplanned ECG/Holter. CONCLUSIONS Atrial fibrillation is extremely common in heart failure with HFmrEF/HFpEF and may inform on symptom evaluation and treatment options. AF screening with an ILR had a much higher diagnostic yield than conventional modalities.
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Affiliation(s)
- Thomas M Gorter
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Vicente A Artola Arita
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Robert G Tieleman
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
- Department of Cardiology, Martini Hospital Groningen, 9728 NT Groningen, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
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Cicogna F, Lanza O, Monzo L, Tota C, Cice G, De Ruvo E, Calò L. The implantable cardiac monitor in heart failure patient: a possible new indication? Eur Heart J Suppl 2023; 25:C344-C348. [PMID: 37125286 PMCID: PMC10132594 DOI: 10.1093/eurheartjsupp/suad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Implantable cardiac monitors (ICMs) have found increasing use in clinical practice over the years, proving, when used in high-risk populations, to facilitate the diagnosis of bradyarrhythmias and tachyarrhythmias requiring treatment. Experience with heart failure patients undergoing pacemaker (PMK) or implantable defibrillator (ICD) implantation, which allow for continuous electrocardiographic monitoring and transthoracic impedance assessment, has made it possible to identify predictors of heart failure flare-ups. In this context, the use of telemonitoring has been shown to ensure better management of patients with heart failure. These benefits cannot be assessed to date in patients with heart failure and left ventricular ejection fraction (LVEF) > 35% who have no indication for PMK or ICD implantation. This population has been shown to have a significant incidence of ventricular arrhythmias and bradyarrhythmias. In addition, a significant number of cerebrovascular events are observed in this population, largely attributable to the high incidence of atrial fibrillation (AF). In this population, the occurrence of AF has also been shown to have a negative impact on patients' prognosis; at the same time, a rhythm control strategy has been shown to be more beneficial in this area than a rate control strategy. Studies also suggest arrhythmias have a negative impact on the cognitive status and quality of life of heart failure patients. These reasons could justify the implantation of ICMs equipped with telemonitoring systems in heart failure patients. The information provided by the monitoring system, if properly managed, could bring benefits in terms of prognosis and quality of life along with a reduction in economic costs. We will try here, by answering a few questions, to assess whether there is an indication for ICM in heart failure, which patients should be candidates and how these patients should be managed.
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Affiliation(s)
| | - Oreste Lanza
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 1069 Rome, Italy
| | - Luca Monzo
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 1069 Rome, Italy
- Centre d’Investigations Cliniques Plurithématique, Université de Lorraine INSERM, Nancy, France
| | - Claudia Tota
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 1069 Rome, Italy
| | - Gennaro Cice
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 1069 Rome, Italy
| | - Ermenegildo De Ruvo
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 1069 Rome, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 1069 Rome, Italy
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McBeath KCC, Angermann CE, Cowie MR. Digital Technologies to Support Better Outcome and Experience of Care in Patients with Heart Failure. Curr Heart Fail Rep 2022; 19:75-108. [PMID: 35486314 PMCID: PMC9051015 DOI: 10.1007/s11897-022-00548-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this article, we review a range of digital technologies for possible application in heart failure patients, with a focus on lessons learned. We also discuss a future model of heart failure management, as digital technologies continue to become part of standard care. RECENT FINDINGS Digital technologies are increasingly used by healthcare professionals and those living with heart failure to support more personalised and timely shared decision-making, earlier identification of problems, and an improved experience of care. The COVID-19 pandemic has accelerated the acceptability and implementation of a range of digital technologies, including remote monitoring and health tracking, mobile health (wearable technology and smartphone-based applications), and the use of machine learning to augment data interpretation and decision-making. Much has been learned over recent decades on the challenges and opportunities of technology development, including how best to evaluate the impact of digital health interventions on health and healthcare, the human factors involved in implementation and how best to integrate dataflows into the clinical pathway. Supporting patients with heart failure as well as healthcare professionals (both with a broad range of health and digital literacy skills) is crucial to success. Access to digital technologies and the internet remains a challenge for some patients. The aim should be to identify the right technology for the right patient at the right time, in a process of co-design and co-implementation with patients.
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Affiliation(s)
- K C C McBeath
- Royal Brompton Hospital (Guy's & St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK
| | - C E Angermann
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Würzburg, Germany
| | - M R Cowie
- Royal Brompton Hospital (Guy's & St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK.
- School of Cardiovascular Medicine, Faculty of Medicine & Lifesciences, King's College London, London, UK.
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A Review of the Wide Range of Indications and Uses of Implantable Loop Recorders: A Review of the Literature. HEARTS 2022. [DOI: 10.3390/hearts3020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Implantable loop recorders (ILR) are devices that are implanted subcutaneously on the chest, which enables the continuous monitoring of arrhythmias for up to three years. These devices have an important role in helping to make a diagnosis and supporting decisions about the best patient management. There are currently three companies that produce ILRs. The Reveal DX and XT device is produced by Medtronic. The Confirm device is produced by Abbott. The Biomonitor III device is produced by Biotronik. The established indications for ILR include the management of transient loss of consciousness and the diagnosis of undocumented palpitations; however, they are also used for less established applications, including atrial fibrillation (AF) monitoring and risk stratification in patients with previous myocardial infarction or inherited cardiomyopathies. There is also diverse literature exploring the use of these devices in other populations, including patients with conditions such as congenital heart disease, amyloidosis, stroke, obstructive sleep apnea, renal transplant and patients who undergo procedures such as AF ablation and coronary artery bypass graft. In this review, we describe how the use of ILR has been applied in different settings, including patients with cardiac and non-cardiac conditions as well as post-cardiac procedures. We then discuss the potential issues related to using ILR in these other indications.
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Aggarwal G, Aggarwal S, Alla V, Narasimhan B, Ryu K, Jeffery C, Lakkireddy D. Subcutaneouscardiac Rhythm Monitors: A Comprehensive Review. J Atr Fibrillation 2021; 13:2387. [PMID: 34950332 DOI: 10.4022/jafib.2387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/15/2020] [Accepted: 01/08/2021] [Indexed: 01/14/2023]
Abstract
Subcutaneous loop recorders (SCRMs) are subcutaneous electronic devices which have revolutionized the field of arrhythmia detection. They have become increasingly appealing due to advances such as miniaturization of device, longer battery life, bluetooth capabilities and relatively simple implantation technique without the need for complex surgical suites. They can be implanted in the office, patient bedside without the need to go to the operating room. One of the most common indications for their implantation is detection of atrial fibrillation (AF) after a cryptogenic stroke. They have also been utilized for assessing the success of rhythm control strategies such post pulmonary venous isolation. More recently studies have assessed the utility of SCRMs for detecting silent AF in at risk populations such as patients with sleep apnea or those on hemodialysis. In this paper, we review the evolution of SCRMs, the clinical studies assessing their value for different indications, their role incurrent clinical practice and future avenues in the era of smart wearable devices like apple watch etc.
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Affiliation(s)
- Gaurav Aggarwal
- Department of Medicine, Jersey City Medical Center, Jersey City, NJ
| | | | - Venkata Alla
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE
| | - Bharat Narasimhan
- Department of Medicine, St Luke's Roosevelt Hospital at Icahn School of Medicine, New York, NY
| | | | - Courtney Jeffery
- The Kansas City Heart Rhythm Institution and Research Foundation, Overland Park, KS
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