Ambulatory Cardiac Monitoring Modalities

Transcription

1 Ambulatory Cardiac Monitoring Modalities NAVIGATING THE CHOICES MKT

2 LEARNING OBJECTIVES Identify the Clinical Applications for Each Modality Define and Distinguish Between the Various Monitoring Modalities 2

3 CLINICAL APPLICATIONS Why Use Ambulatory Cardiac Monitors? Symptom-Rhythm correlation Assess arrhythmia burden Detect asymptomatic arrhythmias Determine appropriate therapy for patient s condition Initiate or titrate medications Anti-arrhythmic medication Beta blockers and Calcium channel blockers Initiation or discontinuation of anticoagulants Other interventions 3

4 TODAY S MONITORING LANDSCAPE FIRST LINE MONITORS SECOND LINE MONITORS Holter Extended Event Mobile Cardiac Telemetry (MCT) Implantable Cardiac Monitor (ICM) Intended Use Monitoring Time Very frequent symptoms Infrequent symptoms or asymptomatic Infrequent symptoms Suspected malignant arrhythmias Rare symptoms; non-diagnostic first line monitor hours 3-14 Days Up to 30 Days Up to 30 Days Up to 3 Years 4

5 DEVICE FUNCTION: SIGNAL CAPTURE CONTINUOUS VS LOOPING CONTINUOUS: Saves full length movie of uninterrupted ECG data from beginning to end of wear period Interrupted Uninterrupted Patient Shower Monitor change out Battery charging Patient Shower No Monitor change No Battery charging Requires patient compliance Imprecise arrhythmia burden and episode duration Requires no patient compliance Precise arrhythmia burden and episode duration LOOPING EVENT: Saves data ONLY for select time before and after a triggered event First in, First out Event based; Cannot provide reliable burden values 5

6 MONITORING OPTIONS: GENERAL DEVICE FEATURES FIRST LINE MONITORS SECOND LINE MONITORS Holter Extended Event Mobile Cardiac Telemetry (MCT) Implantable Cardiac Monitor (ICM) Recording Type Data Reported Data Available During Wear interrupted uninterrupted Loop Interrupted Loop Episodic Episodic Episodic No No Yes Yes Yes 6

7 DEVICE FUNCTION: TRIGGER RECORDING MANUAL VS AUTOMATIC What is a Triggered Event? Manual or Patient: Patient has symptoms and presses button Device stores event data before and after patient trigger Automatic: Device set with specific detection criteria (high and low rate, duration) Device automatically stores data before and after time point when criteria met 7

8 MONITORING MODALITY CONSIDERATIONS PATIENT CLINICAL Lifestyle Ease of use Compliance Cost YOUR AIM: The RIGHT test, the FIRST time Symptom frequency Symptom-Rhythm correlation Arrhythmia burden Final service report 8

9 PATIENT CONSIDERATIONS FIRST LINE MONITORS SECOND LINE MONITORS Holter Extended Event Mobile Cardiac Telemetry (MCT) Implantable Cardiac Monitor (ICM) Compliance for Extended Monitoring Requires Patient Maintenance Difficult Easy Difficult Difficult Easy Yes No Yes Yes No Cost $ $$ $ $$$ $$$$ 9

10 CLINICAL CONSIDERATIONS FIRST LINE MONITORS SECOND LINE MONITORS Holter Extended Event Mobile Cardiac Telemetry (MCT) Implantable Cardiac Monitor (ICM) Symptom Frequency Symptom-Rhythm Correlation Daily Intermittent Daily to Weekly Weekly to monthly Less than monthly Yes Yes Yes Yes Yes Precise Arrhythmia Burden No Yes No No No Final Service Report Comprehensive Comprehensive Event based Event based Event based 10

11 KEY FACTORS: SELECTING A MONITORING MODALITY How active is your patient and will they be proactive in managing their monitor? Patient Device Feature SELECT THE RIGHT TEST THE FIRST TIME Clinical How critical is it to have continuous uninterrupted recording and the impact it has on the ability to diagnose? How frequent are patient symptoms and what is the need for precise arrhythmia burden? 11