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Syncope
Published in Henry J. Woodford, Essential Geriatrics, 2022
An implantable loop recorder is useful when symptoms are infrequent (intervals of greater than every two weeks) and a longer recording period is necessary. This device is placed under the skin much like a cardiac pacemaker. Similar to surface event recorders, it can be activated following a symptomatic episode. The advantage of the device being that it can be used reliably for periods of up to two years. The obvious disadvantages being the requirement for a minor surgical procedure and the financial cost involved. In case series of people without a diagnosis after assessment (total n = 223; mean age 64-71), 20–28% of people had a syncopal event associated with an episode of cardiac arrhythmia during a period of implantable loop recorder use.12–14
Bradyarrhythmias and cardiac pacemakers in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Naktal Hamoud, Fernando Tondato, Win-Kuang Shen
The diagnosis of SND requires documentation of sinus node pauses or sinus bradycardia. ECG and Holter monitor are useful for documentation when these episodes are frequent or persistent. Transient or reversible causes such as drug effect, especially beta-blockers, and electrolyte or endocrinologic abnormalities need to be excluded. An ambulatory event recorder or implantable loop recorder can be considered when clinical episodes are intermittent or infrequent. A treadmill or cycle exercise test is useful in evaluating the response of sinus rate to exercise. Invasive electrophysiology study is no longer routinely recommended for diagnosis of SND due to its low sensitivity and specificity. The inability to correlate symptoms to sinus node abnormalities induced by programmed stimulation is another limitation of electrophysiologic study for evaluation of SND.
Investigations for abnormal cardiac electrophysiology
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
The 12-lead electrocardiogram (ECG) is usually the initial investigation, although it only provides a short snap shot of cardiac rhythm. Even if it has not captured an arrhythmia the 12-lead ECG can still provide significant clues to the diagnosis; e.g. the presence of conduction tissue disease or pre-excitation. However, in order to reach a diagnosis it is usually necessary to capture an episode on ECG to allow symptom rhythm correlation. This can be obtained with non-invasive continuous Holter monitoring or patient-activated ECG recordings, though in the case of infrequent but potentially serious symptoms, a subcutaneous implantable loop recorder can be considered, e.g. ‘Reveal’ device (Medtronic).
The future of cardioneuroablation in cardiovascular medicine
Published in Expert Review of Cardiovascular Therapy, 2022
Tolga Aksu, Asad Khan, Henry Huang
In a retrospective case-control study, we assessed the long-term effect of CNA versus conservative therapy in patients with cardioinhibitory type VVS [50]. The 4-year Kaplan-Meier syncope free rate was 0.86 (95% CI, 0.63–1.00) for CNA group and 0.50 (95% CI, 0.30–0.82) for conservative therapy group. In the first and only randomized controlled trial, Piotrowski et al. [51] compared CNA versus optimal nonpharmacologic therapy in patients with cardioinhibitory type VVS. A total of 48 patients (24 in fragmented electrogram-guided bi-atrial CNA group, 24 in control group) entered the study. The primary endpoint occurred in 2 patients (8%) from the CNA group versus 13 control patients (54%) (P = 0.0004). Quality of life significantly improved in the CNA group (p = 0.0001), whereas it remained stable in control patients. Štiavnický et al. [52] recently presented the use of CNA for the treatment of recurrent swallow syncope. The patient remained asymptomatic after empirical ablation of RSGP via right atrium during the 3-year follow-up. In another case report, CNA was successfully used to treat ictal asystole in a patient with pharmacoresistant focal epilepsy [53]. Lastly, bi-atrial anatomical CNA was performed in a 77-year-old woman with carotid sinus syndrome [54]. The patient was discharged with an implantable loop recorder. After 6 months, she remained free of any symptoms, and no bradyarrhythmias have been registered in ILR.
The challenging management of cardiac involvement in systemic sarcoidosis
Published in Acta Cardiologica, 2022
Chiara Andreoli, Emilia Biscottini, Gianluca Savarese, Federico Fortuni, Johny Helou, Cristina Tutarini, Elisa Quintavalle, Federico Crusco, Francesco Marchetti, Maurizio Scarpignato
An asymptomatic healthy 34 year-old man was occasionally diagnosed with a complete atrioventricular block, no complex ventricular arrhythmias were found on 24-hour Holter ECG recording. Echocardiography as well as cardiac magnetic resonance (CMR) were normal. A chest X-ray showed bilateral pulmonary consolidations and interstitial thickening. A chest computed tomography (CT) showed typical finding of sarcoidosis: multiple subpleuric micronodules, ground-glass opacities and perilymphatic irregular nodular thickening. Excisional supraclavicular lymph node biopsy found noncaseating granulomas confirming the suspected diagnosis. A fluorodeoxyglucose (FDG) positron emission tomography (PET) detected systemic localization of granulomas (Figure 1(A)) and particularly FDG cardiac uptake within the heart (Figure 1(B)). After few weeks of corticosteroid therapy, the AV conduction normalized and a new FDG-PET showed only few lung uptake persistence (Figure 1(C)) without cardiac uptake (Figure 1(D)). To monitor cardiac rhythm, an implantable loop recorder (ILR) was implanted.
Cardiac implantable electronic devices and cybersecurity
Published in Expert Review of Medical Devices, 2021
Bhakti Patel, Amgad N. Makaryus
The implantable loop recorder is a device that is inserted into the patient’s subcutaneous tissue. It functions to diagnose heart rhythm disorders by monitoring the heart rhythm and has the ability to record and store ECGs when a patient is in bradycardia or tachycardia [6]. The remote monitoring feature with the implantable loop recorder provides great benefits, such as decreasing the time it takes to diagnose a patient’s condition as well as the follow-up treatment plan [6]. In a study by Drak-Hernandez et al., the mean time from implant to diagnosis was compared in patients with remote monitoring to those with conventional follow-up appointments following an implantable loop recorder. The results showed that patients with the remote monitoring feature had significantly shorter time to diagnosis and targeted treatment [7]. Additionally, remote monitoring with implantable loop recorders not only enables more timely diagnosis, but also allows data to be transferred in order to prevent memory overflow. This decreases the risk for information loss as a result of memory overflow as well as decreased outpatient visits to record/upload data [7]. For patients with heart failure, the implanted left-ventricular assist device (LVAD) helps the left-ventricle pump blood to the body. Remote monitoring of the LVAD increases the early detection of problems and their treatment [8]. Overall, remote monitoring serves as an advantage for many cardiac devices as it allows for efficient and quick data transfer to the physician as well as early diagnosis of a heart condition.