Implantable Cardiac Monitor (Heart Loop Recorder) Kaitlyn Chin, Alexandra Zega, & Renata Martin

CONDITIONS Unexplainable Heart Palpitations Syncope Abnormal heartbeat Can include skipping beats or tachycardia Syncope A transient loss of consciousness due to low blood flow to the brain Can be caused by abnormal heartbeat Alex

WOLFF-PARKINSON-WHITE SYNDROME Disorder of the conduction system of the heart Caused by the presence of abnormal electrical conduction pathway between atria and ventricle Signs and symptoms Usually asymptomatic (trouble diagnosing) May experience palpitations, dizziness, shortness of breath, or syncope No symptoms are detected through common heart tests (sometimes EP studies may detect extra electrical pathways) Renata Results in episodes of tachycardia Sometimes delta wave is seen in electrocardiogram but very rarely Source: http://www.mayoclinic.com/health/wolff-parkinson-white-syndrome/DS00923

PRIOR DIAGNOSTIC TESTS Patients who report frequent syncope episodes or heart palpitations Several tests are done: Electrocardiogram Stress Testing Cardiac MRI Holter and event monitoring Electrophysiology Study (EP Study) Renata Source: http://www.nlm.nih.gov/medlineplus/ency/article/000151.htm

Advantage Over Conventional Treatment Conventional Testing Insertable Heart Monitor Short term: External Loop Recorders (ELR; Holter) – 2-60 days; poor cosmesis (skin pads and wires) EPS (Electrophysiology Testing) Tilt Test – stressful for patient Long-term use: monitors the heart 24/7 and up to 3 years increases chances of capturing heart signals during infrequent fainting spells. Kaitlyn It is often difficult to induce and observe faintness, , syncope, and tachyarrhythmia palpitation symptoms Holter monitor- samples ECG from skin electrodes and record over a certain period of time. Then the data must be analyzed to locate evidence of an arrythmia episode  diagnose 24 hour segments Loose electrodes produce noise Limited storage capacity

Diagnosis Success Comparison Unexplained Syncope Conventional Testing ICM Kaitlyn After conventional testing – people turn to ICM Sources: Krahn et al. 2001 Heart Monitor: http://www.drugs.com/cg/holter-monitoring.html Medtronic Reveal: http://www.medgadget.com/2009/02/medtronics_reveal_xt_subcutaneous_heart_monitor_now_available_in_the_us.html 20% 43% Diagnosis

COST & INSURANCE Cost per diagnosis of ICM is 26% less than conventional testing Cost is approximently $40,000- $45,000. Monitoring is required after the procedure and cost about $600 a month Most health insurances cover this implant for unexplained fainting spells Charity care can cover if a person does not have insurance Alex

PROCEDURE Area where loop monitor will be inserted is shaved and washed with antiseptic soap. Numb area with local anesthesia. Subcutaneous pocket is made. Insert monitor and close. ICM placement is under the skin over pectoral muscle. Renata Outpatient procedure Usual placement of monitor is four fingers below the collar bone but if patient cant have the implant on that site then monitor can be implanted below the breast.

COMPLICATIONS Allergic reaction Infection Blood clot Fibroblast formation Erosion Device rejection Keloid Formation Device displacement/ migration and/or extrusion Kaitlyn

RECOVERY PROTOCOL May feel sore or discomfort around incision site for a few days Stretching pectoral muscle helps soothe pain from inflammatory response Kaitlyn Will be able to participate in normal activities such as swimming, bathing, and exercise.

THERAPEUTIC PROTOCOL Limit activity, especially lifting until incision is fully healed Doctors may schedule a check-up within a week post-op to check for infection or abnormalities around incision Doctor will also check heart rhythms and ensure ICM is working properly Renata A hand-held battery-operated device about the size of a deck of cards Place over heart monitor and press button to record Handheld device is used to record any events after implantation (monitors and helps diagnose)

EXPECTED OUTCOMES & MONITOR DIAGNOSIS Allows for quicker and more efficient study of heart events Help in diagnosis of palpitations and syncope Can continuously monitor and thus always record events even when they are infrequent Alex

AFTER DIAGNOSIS Catheter ablation Multiple catheters are put into blood vessel (usually groin area) Catheters are guided to heart and small areas of heart tissue where abnormal heartbeats may cause abnormal arrhythmias are ablated Alex After catheter ablation procedure, the ICM can be removed after a year if no other episodes are recorded. Medicine such as adenosine, antiarrhythmic drugs, and amiodarone may be used to control or prevent a rapid heartbeat. If the heart rate does not return to normal with medication, doctors may use a type of therapy called electrical cardioversion (shock). The long-term treatment for Wolff-Parkinson-White syndrome is catheter ablation.

WORKS CITED "After The Procedure." If You Have a Fainting Spell after You Have Your Reveal® ICM, Promptly Call Your Doctor's Office to Schedule an Appointment. N.p., n.d. Web. 03 May 2013. Dugdale, David. "Wolff-Parkinson-White Syndrome: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 03 May 2013. "Insertableloopmonitor." Insertableloopmonitor. N.p., n.d. Web. 03 May 2013. Krahn. "Holter Monitoring." - Care Guide. N.p., n.d. Web. 03 May 2013. "Medtronic’s Reveal XT Subcutaneous Heart Monitor Now Available in the US." Medtronic's Reveal XT Subcutaneous Heart Monitor Now Available in the US. N.p., n.d. Web. 03 May 2013. Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 25 Feb. 2011. Web. 03 May 2013.