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!!