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Νέα μέσα στη παρακολούθηση ρυθμού
X. Kοσσυβάκης
Καρδιολογικό Τμήμα
Γ.Ν.Α. «Γ. ΓΕΝΝΗΜΑΤΑΣ»
Observation diagnosis
Cardiac Diagnostics Landscape
24-Hour Holter
2.5 Million
Event Recorder
1.5 Million
14-30 Day “MCOT”
250,000
Insertable Cardiac
Monitor
25,000
first introduced by the American biophysicistNorman J. Holter (1914–1983) in the 1940s
24-72 hrs
Holter – Short term(Event or MCT) – ICM
Patient Symptoms
2-4 weeks > 30 days
Frequency of symptoms
ECG monitoring technique
ECG Patch Monitoring
Wireless
Zio Patch
single-use, noninvasive, water-resistant,can be worn for up to 14 days.No leads or wires minimal interruption of daily activities.
(2014) 127, 95.e11-95.e17
The Zio Patch detected 57% more (96 versus 61 events; P<0.001) significant clinical events than the conventional Holter. 81% of participants preferred the Zio patch to conventional Holter monitoring; 94% said they found the device comfortable to wear compared with only 52% for the Holter.
several limitations to this technology, 1 lead vs multiple channels available with conventional Holter monitoring. Holter monitor significantly more sensitive for the detection of events over 24
61 events detected over 24 hours with Holterversus 52 events with Zio)
71.1% arrhythmias identified in the first2 days vs 90% by the fifth day of monitoring46.5% in the first 2 days vs 92% of patients by the eighth day
Am J Cardiol 2013;112: 520e524
The smaller the AF burden, the longer the mean time to first detection.
NUVANT Mobile Cardiac Telemetry system
performs real-time analysis and transmission.patient trigger magnet that can be used to collect and transmit symptomatic episodes
34th Annual International Conference of the IEEE EMBS (2012)
SEEQ Mobile Cardiac Telemetry (MCT) System Patient Education
Recordings obtained with the wireless ECG sensor system during outdoor football game training
Medical Engineering & Physics 2013
MyDiagnostick device
•shape of a stick (length 26 cm, diameter 2 cm) holding the device in both hands for 60 s until the result is revealed• diagnose AF in case the arrhythmiais present during at least75%(45 s) of the 1 min ECG recording.•The MyDiagnostick will store up to 140 1 min ECG Lead I strips.
192 patients visiting the outpatient clinic, AF was confirmed on the 12-lead ECG by the cardiologist in53 patients (27.6%).All AF patients were correctly detected by the MyDiagnostick
(sensitivity 100%) 6 out of the 139 recordings during sinus rhythm was considered false positive (specificity 95.9%)Frequent premature atrial or ventricular complexes, sinus arrhythmia and atrial flutter with an irregular ventricular response
Europace (2014) 16, 1291–1295
676 patients (age 74+7.1 years) during 4 h of influenza vaccination. 11 patients (1.6%) subclinical AF all 11 patients had aCHA2DS2VASc-score > 1 requiring anticoagulation6 patients had a false positive reading, (specificity 99%)
Implantable Loop Recorders
REVEAL XT, Medtronic St Jude, Confirm
3-year longevity for long-term monitoring1
MR conditional labeling for safe patient management‡
Medtronic CareLink® Network compatibility for remote monitoring
Class I. ILR is indicated:
In an early phase of evaluation of patients with recurrent syncope of uncertain origin who have:–absence of high-risk criteria that require immediate hospitalizationor intensive evaluation–a likely recurrence within battery longevity of the device (Level ofevidence A) In high-risk patients in whom a comprehensive evaluation did not demonstrate a cause of syncope or lead to specific treatment (Level of evidence B)
Class II A. ILR may be indicated:
To assess the contribution of bradycardia before embarking on cardiac pacing in patients with suspected or certain neurally mediated syncope presenting with frequent or traumatic syncopal episodes (Level of evidence B)
Example of a stored AF episode
87% Smaller* than Reveal® XT ICM
Linear dimensions rounded to the nearest mm
Volume rounded to the nearest tenth of a cc
Reveal LINQ ICM
20% more data memory*
Improved AF-detection algorithm
3-year longevity for long-term monitoring6
MR-Conditional at 1.5 and 3.0 Tesla†
*Compared to Reveal XT ICM
† Reveal LINQ ICM has been demonstrated to pose no known hazards in a specified MR environment with specified conditions of use. Please see Reveal LINQ ICM clinician manual for more details.
87% Smaller* with Enhanced Capabilities
Improved AF Detection AlgorithmsNominal Programming Based on Patient Type
Improved AF Detection Algorithms
P-Sense Capabilities
• Improved differentiation between true AF episodes and runs of atrial
ectopy with irregular coupling intervals and sick sinus in the form of the
brady-tachy12
• In addition to the R-R interval based AF evidence score, a P-wave
evidence score is computed and subtracted from the AF evidence score
before a comparison is made to an AF threshold. The P-wave evidence
score is used as evidence against the presence of AF.
Improved AF Detection Algorithms
False episodes reduced by 46%12
Reveal LINQ ICM Insertion Location
Remote Monitoring of Pacemakers andImplantable Cardioverter-Defibrillators
General set up of current remote monitoring systems
Devices diagnostics
They fully document the timing of atrial arrhytmias onset and record the duration and frequency of episodes
Summary of studies on AF detected by dual-chamber cardiac implantable electronic devices and
thromboembolic risk
Device-Tailored Anticoagulation
In patientswith low- to intermediate-CHADS2
scores and lowburdens of AF, the risk of thromboembolism may
be low enough to start or stop anticoagulation!!!
Temporal relationship of device-detected AF to thromboembolic events
Finger contact activates ECG recording of bipolar lead I (right hand to left hand).sensitivity 98%, specificity 97%, overall accuracy 97% .Screening Education And Recognition inCommunity pHarmacies of Atrial Fibrillation to prevent stroke in an ambulantpopulation aged ≥65 years (SEARCH-AF stroke prevention study): a cross-sectionalstudy protocol. BMJ Open 2012
Jerrett K. LauI et al,(2013)International Journal of Cardiology
conclusions
Technological advances dramatically changes patients monitoring.
Wireless ECG patch could reliably replace the conventional Holter and external loop recorders
Newer more sophisticated and delicated implantable loop recorders permit longer and more accurate cardiac rhythm monitoring.
NO BODYNO CRIME!!
NO RECORDINGNO DIAGNOSIS!!