Long-term monitoring with implantable cardiac monitor: Reveal, Biomonitor or Confirm RX.

Recording the cardiac electricity over a long period provides information about your heart rate, the regularity of your heartbeat, whether there are moments of electrical silence, and more.

This information helps in the diagnosis of certain health conditions, including: syncope (unconsciousness) of unknown causes, suspicion of cardiac arrhythmias (eg, atrial fibrillation) that caused a stroke (paralysis), as well as some uncomfortable palpitations not detected by standard recording methods.

But before we get into the subject, it is good to review some basics.

 

The electrical system of the heart and its recording

The heart is a great pump that ensures blood circulation throughout the body. To achieve this, each beat requires an electrical pulse that spreads along a conduction network. This normally results in a regular heartbeat whose frequency varies according to the specific needs in each given situation.

Cardiac electrical signals can be recorded by placing small sensors (electrodes) on the skin and transcribed on a graphic document. This is the basic principle of the electrocardiogram (ECG), frequently used for many, many years. This basic exam in cardiology is however limited to a recording of ten seconds only. The diagnosis of cardiac arrhythmias most often requires more prolonged monitoring obtained by various methods which will be described later.

The recording of the heart's electricity can be done in different ways, either over a short period of time or over a more or less prolonged period of time. For example, the electrocardiogram records it for a few seconds, while the Holter monitor records for a period of 24 or 48 hours.

 

Two types of long-term registration

There are various types of monitors that record cardiac signals over longer periods of time. These systems collect cardiac signals either at the surface on the skin (external) or through a miniature monitor that is implanted under the skin (internal).

 

Long-term subcutaneous (internal) registration

 

The implantable cardiac monitor

The Reveal, Biomonitor and Confirm RX are implantable monitors that continuously record the electricity emitted by the heart.

The heart electrical signals are detected by this internal monitor, inserted under the skin, in front of the left chest region.

This miniature device includes an electrode, a data logging system and a battery for continuous detection of cardiac signals lasting up to 2 to 3 years.

In addition, the data collected is relayed by a wireless electronic communication system to a secure device which subsequently redirects this data to the treating team.

 

Different manufacturers

Various devices from different manufacturers are used (Reveal LINQ *, Confirm RX *, Biomonitor *).

 

You have to make an appointment

This implantation must be recommended by your doctor or a cardiologist. The latter issues a request to this effect. A confirmation of the date and time of the appointment for this procedure is sent to you by phone or mail.

 

The day of the appointment

There is nothing special to plan for the day of your appointment. You do not have to fast unless you are otherwise told so. It is recommended that you bring an up-to-date list of your medications.

 

Easy and fast installation

Formerly, a small surgery was performed in the operating room or electrophysiology laboratory.

The device was the size of a USB key and the battery could last 18 months. The patient had to go at least twice a year to have the device checked. The inspection was the same as for a cardiostimulator where a device was  placed on the implantable monitor.

Now the device the length of a AAA battery is 2 times smaller. It measures, depending on the model, approximately 5 mm x 7 mm x 4 mm and is practically not visible on the surface of the skin and does not limit any movements. It helps to lead a normal life.

 

The monitor is implanted or rather pushed under the skin by an injector system that requires only a tiny incision of about 5 mm. Everything is done under local anaesthesia in the electrophysiology room or at the clinic where day-surgeries are performed. It is a very short procedure of less than 20 minutes.

 

 

Implantation technique

Inserting the monitor is usually done while lying on your back or in a slightly inclined position. The left pectoral area is disinfected to prevent infection.

Local anaesthesia, such as at the dentist's, is administered at the insertion site. This is the only moment of discomfort during the procedure.

A small incision of a few millimetres is done and the implantation is performed.

It is then verified that the detection of the cardiac signals is adequate. After these various steps, the wound is closed by one or two resorbable stitches or with butterfly closures. A thin bandage is applied that you will need to remove after a week.

 

Low complication rate

The installation of the heart monitor is safe. Possible complications are local bleeding, infection or skin erosion. These complications are very rare and not severe.

It may happen that a slight sensitivity persists at the site of implantation, but it disappears rather quickly in the days following the intervention.

 

 

Compatible with a magnetic resonance imaging

The implantable monitor is not a problem for magnetic resonance examinations.

 

Metal detector

The presence of the device can be detected by a metal detector.

During an inspection at customs, it is best to have the explanatory note describing this device close by.

 

Longevity of the device

The implantable monitor has a battery that lasts 2 to 3 years. It is removed only when the battery is dead or if the arrhythmia has been identified, or if the problem has been discovered.

 

How the Monitor functions

The device continually monitors the heartbeat for arrhythmia or any abnormal cardiac electrical signals.

Depending on pre-set parameters, adjusted to your condition and what you are looking for, the internal monitor automatically records any significant anomalies and sends this information to a remote tracking system without you even noticing.

 

And if you feel something

In addition, you can activate a recording at any time using a remote control when you feel symptoms and identify the rhythm of your heart at that very moment.

You can keep a small journal of your palpitations that you will give to the health professional to corroborate the information recorded.

 

 

Transmission of information

Depending on the model of the monitor you will receive, you will be provided with a remote tracking device that you will need to plug into a room of your house where you frequently enter (bedroom, living room or kitchen).

Whenever you are near the Remote Tracking Device, it will connect to your internal monitor to check for significant arrhythmias. If this is the case, this information is sent to the treating team so that you and your doctor will be notified as soon as possible.

You will receive a call if a doubtful arrhythmia occurs.

 

 

A transportable system

This communication device for remote tracking is easy to move. So you can take it with you when you leave the house.

 

 

 

For some other monitor models, instead of a remote tracking device, there is the possibility of having an application that can be downloaded to your smartphone or tablet and that transmits information to the treating team.

 

 

 

An additional result for another doctor

A copy of the results will be sent to your referring doctor and, according to your request, to any other professional registered in your file.

All you need to do is give the name and contact information of this doctor to the staff.

 

Remove the device

The removal of the device is simple to do and can be done in any office or other place where the environment is sterile. The device is removed when the battery is dead or if the answer to the problem has been found.