Sometimes good things really do come in small packages.
For people who have suspected heart problems that are difficult to diagnose and may require extended monitoring, the good news is that a new generation of an insertable cardiac monitor (ICM) is available that is so small it is virtually impossible to see in most people.
“Once the new ICM is implanted and healed, you can’t really visually detect where it is in most cases. We usually have to palpate it to determine the exact location,” Trinity interventional cardiologist Timothy Lee, MD, said. “Patients don’t have to be concerned that it might be obvious to others or interfere with things they need to do.”
The Reveal LINQ™ Insertable Cardiac Monitor launched in February by Medtronic is about 80 percent smaller than the previous design and has 20 percent more data memory. The device can be programmed to automatically record heart activity before, during and after a cardiac event, and a manual option is available that can activate a handheld recorder when patients are aware of symptoms. It is also designed to be used in an MRI setting if needed.
“We usually reserve this type of monitor for patients with difficult-to-diagnose symptoms we suspect may be cardiac related, but with intervals between occurrences that make them unlikely to be detected by a 24-hour halter monitor,” Lee said.
Lee recently implanted the state’s first miniaturized version of the ICM in the upper left chest of a 64-year-old male patient at Trinity Medical Center, the latest first in the hospital’s long history of firsts in cardiac care.
“Since the ICM is so small, it can be easily implanted in a minimally invasive procedure in an outpatient setting,” Lee said. “The tiny incision requires only a local anesthetic to numb the area. In just a few minutes, the ICM is in place and the patient is ready to go on about his day”
The system immediately begins continuous wireless monitoring.
“I use the CareLinkR network to check data on recent heart activity,” Lee said. “I can also request an alert notification if a patient has a cardiac event, so I can go online to see what is happening.”
Like many of the symptoms that bring patients to their doctor’s office with questions, fainting may be harmless, or something more serious. Cardiac syncope can increase six-month mortality rates by 10 percent. ICM data provides clues to help physicians get to the root causes of fainting faster. It can help distinguish whether palpitations are related to stress, or if an irregular heartbeat may be heralding the onset of atrial fibrillation that could increase the risk of heart disease and strokes. After ablation, an ICM can also be helpful in following the patient’s condition.
ICM data may indicate whether dizziness is more likely to be an inner ear problem, related to changes in blood pressure or possibly a heart or neurological issue that needs immediate attention.
Approximately 30 percent of ischemic strokes are cryptogenic and why they happen remains a mystery. In some cases, ICM can help to identify the cause so treatment can begin to reduce the risk of future strokes.
In cases where there is a family history of serious heart rhythm disturbances or sudden cardiac arrest, the monitor may offer valuable insights on whether the trait is affecting the individual patient’s health.
“Although the ICM is designed to remain in place up to three years, with a battery to sustain it that long if needed, most of these hard-to-diagnose conditions are tracked down much faster, usually within a year or less,” Lee said. “That can make an enormous difference in the lives of patients who may be at risk of something serious occurring if the underlying cause remains unknown and untreated. It can also help to reduce the cost, discomfort and frustration of having to go through a long series of tests trying to rule out possible causes that may still remain elusive.”
Though it is the smallest device of its kind, the Reveal LINQ™ ICM has an enormous range. It uses global cellular technology to transmit diagnostic data from just about any location in the world. Having the implant in place doesn’t limit the ability to travel on business or interfere with vacation plans as long as the patient is well enough to go.
“Another aspect I’m finding useful is how the ICM can be used as a tool to show me in real time whether and how well the treatment I’m using is working,” Lee said. “I can see if a patient is responding to a drug, and whether adjusting the dosage up or down is having a positive effect. It helps me tailor the best treatment to the individual patient.
“With this technology, making a difficult diagnosis is simpler for the physician, and the whole experience of getting answers and the most effective treatment is easier for patients.”
Key words
The Reveal LINQ™ Insertable Cardiac Monitor ICM Timothy Lee, MD Interventional Cardiology Trinity Medical Center difficult diagnosis arrhythmia atrial fibrillation ablation CareLinkR network cryptogenic stroke rhythm disturbance
