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

2. 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

3. 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:

4. 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:

5. 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

6. Diagnosis Success Comparison
Unexplained Syncope
Conventional Testing
ICM
Kaitlyn
After conventional testing – people turn to ICM
Sources:
Krahn et al. 2001
Heart Monitor:
Medtronic Reveal:
20%
43%
Diagnosis

7. 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

8. 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.

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

10. 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.

11. 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)

12. 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

13. 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.

14. 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 Web. 03 May 2013.