Continuously records and deletes the patient’s
Patient-activation function ECG and auto activation (daily automatic) transmissions for pre-specified criteria.
Capture of arrhythmic events without relying on patient compliance or perception of symptoms
RETROSPECTIVE (LOOP) MEMORY
Patients with infrequent short duration transient symptoms,
recurring over months
Subcutaneous Electrocardiographic (ECG) Monitoring Device
Reveal® Plus ICM Reveal® DX Reveal® XT ICM
2000 2007 2009:
Sensing Onda R Soglia fissa Soglia dinamica
Risposta alle interferenze
Soglia dinamica
Risposta alle interferenze
Trigger episodi Asistolia, Bradicardia,
Tachicardia
Asistolia, Bradicardia
VT/FVT
Asistolia, Bradicardia
VT/FVT, AT/AF
Diagnostica estesa no no
AF detection
Burden AT/AF, HRV, Attività del paziente, FC Diurna/Notturna,
Cardiac Compass
Sistema di mappaggio Cardboard Vector Check Vector Check
Interfaccia utente No Medtronic standard Medtronic ICD style Medtronic ICD style
Durata 14 mesi 3 anni 3 anni
Memorizzazione Eventi 42 min. 49.5 min. 49.5 min.
Patient Assistant Singola funzione:
Sintomo
Doppia funzione:
Sintomo e feedback
3 funzioni: Sintomo, Feedback e query
Risonanza magnetica no Si Si
Remote Monitoring no Medtronic CareLink® Network Medtronic CareLink® Network
6
7
CARATTERISTICHE VALORE
Dimensioni (altezza x larghezza x spessore) 56,3 mm x 18,5 mm x 8 mm
Volume 6,5 cc
Peso 12 g
Longevità stimata 3 anni
56,3 mm 8 mm
18,5
mm
Gli elettrodi sottocutanei sul dispositivo semplificano la procedura di impianto ed eliminano la necessità di utilizzare elettrodi transvenosi
Posizionamento degli elettrodi appositamente studiato per avere un riconoscimento migliore degli episodi grazie ad un buon contatto tra sensore e tessuto
Elettrodo frontale Elettrodo retro
Uses the same interval, interval average algorithm that ICDs use to bin or classify intervals as Tachy, Brady or Asystole.
• SJM Confirm™ Implantable Cardiac
Monitor (ICM)
• Patient Activator
• Merlin™ Patient Care System (PCS)
• Transtelephonic service provider
A weekly trend based on the percentage of time the patient spent in atrial
fibrillation based on the AF duration programmed in parameters.
Will also be displayed on the FastPath™
Provides the mean ventricular rate during AF and a histogram of recorded AF
episode durations
Provides a link to the AF Diagnostics screen.
Parameter Reveal LINQ ICM
Longevity *3 years
Long 7.2 mm
Wide 4.0 mm thick
WEIGH 2.5 g
Electrode Spacing (inside-to-inside) 38 mm
Volume 1.2 cc
Mass 2.5 g
Episode Storage 59 min
Patient Symptom Mark Patient Assistant
Cardiac Compass® Same
MRI Compatibility MR Conditional
Clinician Notification Nightly Transmission / CareAlert
Notifications
Bi-Directional Telemetry B
Detection Algorithms Full View + P-SENSE detection
CareLink® Network Yes
Wireless Telemetry 1-Way, Transmit Only
Insertable
Automatic transmission
AF detection
P-sense
Cardiac Compass®
Electrodes on the ends of the device record
ECG signals
An embedded accelerometer measures
patient activity
Uses wireless telemetry for remote
monitoring of patients (including nightly
automated transmissions)
2014
LINQ Device
Tool di inserzione Tool di Incisione
+
87% PIU’ PICCOLO DEL Reveal® XT
Benefici della miniaturizzazione
12
Simplify implantation
procedure
Increase patient acceptance
Enhance the device’s AF detection capabilities.
13
TECHNOLOGICAL ADVANCES
Reveal LINQ e Trasmissione Wireless
Carelink Network
CareAlerts
Segnalazione con un Event Report, contenente
•Dati Device (i.e. Batteria)
•30 s di ECG di un Episodio, secondo le priorità impostate
•Numero Episodi
No Segnalazione
Disponibili: i Dati Device, 10 sec di ECG Corrente ed i contatori
Disponibili 30 sec di ECG trasmesso nella lista episodi
Ogni 31 gg, un Summary Report verrà comunque generato con i Dati Device, i 10 sec di ECG Corrente e contatori dall’ultima trasmissione, Trend e Cardiac Compass
:
New Frontiers in Cardiac Monitoring
Patient
Assistant
Cellular
• Sincope
• Palpitazioni
• Convulsioni
• Tachicardia ventricolare
• AF sospetta
• Ablazione AF
• Gestione AF
• Ictus criptogenetico
• Altro
Selezionare la Ragione del Monitoraggio:
La scelta del motivo del monitoraggio permette una preselezione della programmazione più specifica
17
18
• Its smaller size makes it much more suitable for children and infants
• It is technically easy to implant • Automatic transmission to
CareLink • Ideal for patients asymptomatic
who require constant monitoring
11-MONTH-OLD boy with tuberous sclerosis with frequent ventricular arrhythmias secondary to cardiac Rhabdomyomas.
Cardiology in the Young (2015), 25, 1221–1223
Conclusions: The miniaturized Reveal LINQ ICM supports arrhythmia detection and monitoring, achieving adequate sensing performance without safety issues
Heart Rhythm, Vol 12, No 6, June 2015 1116
Incidence of AF episodes
Duration of AF Cumulative time
spent in AF
(AF burden)
Ventricular rate during AF
Average Day Night Heart Rate Heart Rate Variability
Patient Activity
Can store up to 14 AF episodes with electrocardiogram (ECG) data after which the earliest episode gets overwritten by
newer episodes
20
mfalse positive Duration 55% Number of 46%
Purerfellner H, Heart Rhythm 2014; 11: 1575–1583.
Symptom- Rhythm Correlation
-Management of transient loss of consciousness (T-LOC)
-Evaluation of syncope
Management of Palpitations
Silent Atrial Fibrillation
22
WITH 3 YEAR BATTERY LIFE OFFERS THE BEST OPPORTUNITY FOR
DIAGNOSIS
In patients with frequent recurrences of unexplained syncope, the 2009 European Society of Cardiology (ESC) guidelines now advocate the “early” use of ILRs.
• Prospective, Multicenter, observational study • 570 pts with recurrent unexplained presyncope
or syncope • ILR provided a diagnosis in 78% of the patients
Brignole et al. Europace (2009) 11, 671–687
Task Force
Suggested ECG monitoring techniques
depending on symptom frequency
Diagnosing bradyarrhythmic syncope after the
initial evaluation: most useful tests
Non-invasive evaluation of patients with
suspected or known ventricular arrhythmias
Time ICM (%) Control (%) Hazard Ratio
P
6 months 8.9 1.4 6.4 0.0006
12 months 12.4 2.0 7.3 0.0001
3 years 30.0 3.0 8.8 0.0001 29
N Engl J Med 2014;370:2478-86
Dramatic increase in the detection rate (30% versus 3%)
of atrial fibrillation at 36 months.
Implantable REVEAL XT Device Conventional Monitoring
441 pts
End Point Primario
End Point Secondario
Heart Failure
Bradycardia
Atrial
Fibrillation
Tachycardia
Manage
Treat Predict
Diagnose
• ILRs is safe and cost-effective and has a high diagnostic yield
• Maximizes clinical benefits while simultaneously lowering costs or improving economic
2015
Heart Rhythm, Vol 12, No 7, July 2015