Remote Monitoring and Injectable Cardiac Monitors
By Dr Khaled Awad, Mercy Clinic Heart and Vascular, St. Louis, MO
A major challenge in most specialties of medicine involves moving from vague, diffuse symptoms to accurate diagnosis. This can be particularly challenging in cardiology.
Symptoms of lightheadedness, dizziness, presyncope, palpitations, and the like may be passing symptoms of a benign condition or they may be linked to a potentially serious, even life-threatening condition. Arrhythmias are associated with a number of symptoms that are common to many disorders. While arrhythmias can be documented and analyzed on an electrocardiogram (ECG), the nature of paroxysmal and nonsustained arrhythmias often precludes capturing them on a standard 12-lead ECG.
Holter monitors are an option, are often reimbursed, and can be effective, but have numerous drawbacks, in that they are bulky, uncomfortable, and the adhesive electrodes may irritate the patient’s skin. Patient compliance with Holter monitoring is suboptimal, particularly when the patient may be required to wear the device for an extended period of time.
Insertable cardiac monitors, sometimes called loop recorders, were developed to provide a more comfortable and more efficient way to get the same data. A small device is inserted subcutaneously near the heart. No wires or external patches are needed. It monitors the heart and sends data back to a receiver for subsequent analysis. For most patients, the low-profile design of these monitors enhances patient comfort and the remote monitoring system requires little to no intervention on their part. Many companies have developed this sort of device, which are effective and widely used.1
The next-generation of cardiac monitor has arrived in the form of BIOTRONIK’s BIOMONITOR IIIm, a radically downsized monitor that can be subcutaneously injected into the body in a simple step using the proprietary FIT OneStep insertion tool. Once inserted into the body, the monitor is able to record cardiac activity, which can then be transmitted to the BIOTRONIK Home Monitoring bedside receiver. Alerts can be set up so that certain information automatically generates a special notification to the clinic. Home Monitoring collects information every night with no patient intervention or interaction. Patient compliance was studied for the earlier BioMonitor 2 Pilot Study and found excellent transmission success rates and patient compliance.2
"Patient compliance was studied for the earlier BioMonitor 2 Pilot Study and found excellent transmission success rates and patient compliance."
For example, a patient who has symptoms that suggest a potential arrhythmia but whose ECG is normal may be having short runs of non-sustained ventricular tachycardia (NSVT), which can come to light when ventricular rates exceed normal programmed limits. Likewise, the system can be set up so that atrial fibrillation triggers an alarm, even if it occurs only occasionally and resolves spontaneously. Trying to capture occasional episodes of NSVT can be extremely challenging without the help of advanced technology—and BIOMONITOR IIIm can help meet this need.
Why BIOMONITOR IIIm with Home Monitoring is Such a Powerful Combination
The injectable BIOMONITOR IIIm is a tiny device that can be quickly and easily injected into the patient and can be worn comfortably for years. It monitors cardiac activity round the clock, day in and day out, with excellent signal fidelity. Unlike bulky Holter monitors, the small device is barely noticeable to the patient. It uploads nightly to the Home Monitoring system, which can then transmit the data to the clinic. The system can be set up to flag certain remarkable rhythms, such as a possible ventricular tachycardia, atrial tachycardia, bradycardia, and asystole. The system can be configured to alert the clinic either via email or text message, or alerts can be sent to the website only depending on the importance of the alert type. Either method ensures that the clinic gets the data quickly, in most cases more rapidly than would occur with a Holter monitor or just periodic in-office ECGs.
Many arrhythmic events are asymptomatic3 so when paired with BIOTRONIK Home Monitoring, the BIOMONITOR IIIm could detect them before patients even know they had occurred. If the patient experiences symptoms and is able to interact with the transmitter, he or she can also trigger a patient-initiated report. Otherwise, alerts will flag these unusual events.
1. Mayo Clinic. Implantable Loop Recorder. Mayo Clinic,. Electrocardiogram (ECG or EKG) Web site. https://www.mayoclinic.org/tests-procedures/implantable-loop-recorder/pyc-20384986. Published 2019. Accessed November 14, 2019.
2. Ooi SY, Ng B, Singarayar S, et al. BioMonitor 2 Pilot Study: Early Experience With Implantation of the Biotronik BioMonitor 2 Implantable Cardiac Monitor. Heart Lung Circ. 2018;27(12):1462-1466.
3. Gegenava T, Gegenava M, Kirtava Z. Arrhythmia telemonitoring in asymptomatic patients. Journal of Electrocardiology, July 2013, Vol46(4), ppe4-e5. 2013.