Implantable physiologic monitors Flashcards
Provides an understanding of the clinical application of loop recorders. Currently weighted 1.5% in the CCDS exam.
True / False
Implantable Cardiac Monitors (ICM) are sometimes referred to as loop recorders.
True.
This is due to the recording nature of continual overwriting, which is dictated by these devices having a small memory capacity.
True / False
The typical location of an ICM is in the left parasternal area of the chest.
True.
Site provides good R-wave amplitude and analyzable P, QRS, and T waves on the IEGM.
What other site is available for loop insertion should cosmetic concerns be present?
Left axillary position.
Incise at the fourth intercostal space, level with the left anterior axillary line. Insert loop parallel to intercostal space.
True / False
Aside from ICM use as diagnostic tools to evaluate symptoms such as syncope and palpitations, ICMs can also be used to assess epilepsy and unexplained falls.
True.
Such applications are less well defined in the literature however.
True / False
ICMs are indicated in compliant patients with frequent symptoms.
False.
Holter monitoring would be indicated here as symptoms are frequent enough. ICMs are generally indicated to non-compliant patients and/or with infrequent symptoms.
What is a major limitation of ICMs when compared to Holters?
Complication around insertion site.
What is the indication class for ICMs used to assess unexplained syncope?
Class I.
The use of ICMs in patients with infrequent unexplained palpitations is which indication class?
Class IIa.
The use of ICMs in patients whom epilepsy is suspected but the treatment has proved ineffective & in patients with established epilepsy in order to detect peri-ictal cardiac arrhythmias that require treatment is which indication class?
Class IIb.
What is the reported complication rate associated with ICM insertion?
<1%.
True / False
ICMs have been shown to be effective in identifying atrial fibrillation in cryptogenic stroke patients.
True
What is the approximate longevity of modern day ICMs?
3 to 5 years.
The following statment is which ICM indication classification?
‘To evaluate selected ambulatory patients with syncope of suspected arrhythmic etiology, an ICM can be useful’.
Class IIa.
The following statment is which ICM indication classification?
‘High risk patients in whom a comprehensive evaluation did not demonstrate a cause of syncope or lead to a specific treatment’.
Class I
The following statement is which ICM indication classification?
‘Early phase of evaluation in patients with recurrent syncope of uncertain origin, absence of high risk criteria, and a high likelihood of recurrence within battery longevity of the device’
Class IIa
List 3 major studies that highlight the efficacy of ICMs with respect to subclinical AF in patients at high risk of stroke and AF (CHADS >2).
- PREDATE AF (2017)
- ASSERT II (2017)
- REVEAL-AF (2017)
Unexplained syncope / Palpitations / Subclinical AF
RAST (2001) and PICTURE (2011) are two landmark studies which highlight the efficacy of ICMs with respect to detection of _______.
Unexplained Syncope.
The following loop IEGM likely shows what arrhythmia?
Atrial arrhythmia - likely AF due to irregular cycle length.
Ventricular arrhythmias would likely present with broader QRS complexes than that of the preceding sinus beats.
The following loop tachogram and lorenz plot show what?
Initiation and termination of tachycardia.
*Note the device defines this as a High Ventricular Rate only. With no dedicated atrial or ventricular IEGMs, its impossible to discern tachycardia origin with absolute accuracy.
