PURPOSE: Diagnosing atrial fibrillation (AF) is highly relevant, as specific secondary prevention is of high importance. Recently, insertable cardiac monitors (ICMs) have been introduced for continuous monitoring to detect asymptomatic episodes of AF. The detection of AF remains challenging due to a relevant incidence of artifacts. This study aimed to compare the effectivity of ICM when placed in a subcutaneous or in a submuscular localization, respectively. METHODS: We retrospectively analyzed data from 30 patients undergoing pulmonary vein isolation (PVI) for AF and consecutive ICM implantation. ICMs were implanted in two locations: either subcutaneously and parasternally (SC) or under the left major pectoral muscle (SP). Interrogations were continuously retrieved using remote monitoring and during repeated visits in our outpatient clinic. The transmission protocols were scanned for detected AF, and it was ruled by two blinded investigators, if detection was correct or incorrect. RESULTS: Mean age was 67 ± 10 years, 56% men, 50% paroxysmal AF. In 14 of the patients, the ICM was implanted at a SC localization and in 16 patients subpectorally. R-wave amplitude was significantly higher in patents with SP implantation. There were 670 transmitted protocols including 1024 episodes detected as AF. Of these, 54% were correctly recognized as AF in the SC group. In the SP group, 85% of the recorded episodes were correctly recognized as AF (p = 0.03). The remaining episodes in both groups showed sinus rhythm with misinterpreted artifacts. CONCLUSIONS: To improve effectiveness of detecting AF episodes, it is useful to implant subpectorally.
PURPOSE: Diagnosing atrial fibrillation (AF) is highly relevant, as specific secondary prevention is of high importance. Recently, insertable cardiac monitors (ICMs) have been introduced for continuous monitoring to detect asymptomatic episodes of AF. The detection of AF remains challenging due to a relevant incidence of artifacts. This study aimed to compare the effectivity of ICM when placed in a subcutaneous or in a submuscular localization, respectively. METHODS: We retrospectively analyzed data from 30 patients undergoing pulmonary vein isolation (PVI) for AF and consecutive ICM implantation. ICMs were implanted in two locations: either subcutaneously and parasternally (SC) or under the left major pectoral muscle (SP). Interrogations were continuously retrieved using remote monitoring and during repeated visits in our outpatient clinic. The transmission protocols were scanned for detected AF, and it was ruled by two blinded investigators, if detection was correct or incorrect. RESULTS: Mean age was 67 ± 10 years, 56% men, 50% paroxysmal AF. In 14 of the patients, the ICM was implanted at a SC localization and in 16 patients subpectorally. R-wave amplitude was significantly higher in patents with SP implantation. There were 670 transmitted protocols including 1024 episodes detected as AF. Of these, 54% were correctly recognized as AF in the SC group. In the SP group, 85% of the recorded episodes were correctly recognized as AF (p = 0.03). The remaining episodes in both groups showed sinus rhythm with misinterpreted artifacts. CONCLUSIONS: To improve effectiveness of detecting AF episodes, it is useful to implant subpectorally.
Authors: Valentin Fuster; Lars E Rydén; David S Cannom; Harry J Crijns; Anne B Curtis; Kenneth A Ellenbogen; Jonathan L Halperin; Jean-Yves Le Heuzey; G Neal Kay; James E Lowe; S Bertil Olsson; Eric N Prystowsky; Juan Luis Tamargo; Samuel Wann; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffery L Anderson; Elliott M Antman; Jonathan L Halperin; Sharon Ann Hunt; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Silvia G Priori; Jean-Jacques Blanc; Andrzej Budaj; A John Camm; Veronica Dean; Jaap W Deckers; Catherine Despres; Kenneth Dickstein; John Lekakis; Keith McGregor; Marco Metra; Joao Morais; Ady Osterspey; Juan Luis Tamargo; José Luis Zamorano Journal: Europace Date: 2006-09 Impact factor: 5.214
Authors: Jeff S Healey; Stuart J Connolly; Michael R Gold; Carsten W Israel; Isabelle C Van Gelder; Alessandro Capucci; C P Lau; Eric Fain; Sean Yang; Christophe Bailleul; Carlos A Morillo; Mark Carlson; Ellison Themeles; Elizabeth S Kaufman; Stefan H Hohnloser Journal: N Engl J Med Date: 2012-01-12 Impact factor: 91.245
Authors: Carsten W Israel; Gerian Grönefeld; Joachim R Ehrlich; Yi-Gang Li; Stefan H Hohnloser Journal: J Am Coll Cardiol Date: 2004-01-07 Impact factor: 24.094
Authors: Suraj Kapa; Andrew E Epstein; David J Callans; Fermin C Garcia; David Lin; Rupa Bala; Michael P Riley; Mathew D Hutchinson; Edward P Gerstenfeld; Wendy Tzou; Francis E Marchlinski; David S Frankel; Joshua M Cooper; Gregory Supple; Rajat Deo; Ralph J Verdino; Vickas V Patel; Sanjay Dixit Journal: J Cardiovasc Electrophysiol Date: 2013-04-11
Authors: Charlotte Eitel; Daniela Husser; Gerhard Hindricks; Manuela Frühauf; Sebastian Hilbert; Arash Arya; Thomas Gaspar; Ulrike Wetzel; Andreas Bollmann; Christopher Piorkowski Journal: Europace Date: 2011-02-16 Impact factor: 5.214