Rhythm Monitoring and Remote Monitoring
Sometimes, we do not have an immediate answer for a patient’s symptoms that sound like they may be related to a heart rhythm disorder. It is important to have the proper diagnosis prior to starting treatment.
There are two types of monitoring methods available to provide accurate and useful data to help make a diagnosis.
Non-Invasive Ambulatory Monitoring
This type of monitoring is performed on patients who have frequent symptoms that will be present within a two-week period. At the Heart Rhythm Center of Temecula, we use a remote monitoring device called the Zio patch. This is a low-profile device that sticks to the skin right under the collarbone. It records all of the heartbeats and rhythms the entire time the device is worn. There are no wires and the patch allows the patient to perform their normal activities without limitations, making it more likely that we will uncover the cause of symptoms. The Zio patch can be worn for as little as three days and as many as 14. Your physician will analyze the data once the device has been mailed back to the manufacturer and downloaded onto a secure system.
Minimally Invasive Monitoring
If symptoms are less frequent in nature but just as concerning, then the Zio patch may not be the appropriate tool. For longer term monitoring (up to three years), the implantable loop recorder is a good choice. This type of device is inserted under the skin over the chest wall near the heart. The device records all the heartbeats and separates the unusual rhythms into separate bins for analysis. The specific bins are slow heart rhythms, fast heart rhythms, atrial fibrillation and patient symptoms. The device stores the abnormal rhythms and sends them to your physician’s office over a secure system before beginning the next 24-hour loop of recording.
This type of device is frequently used in patients with fainting that has not been explained, atrial fibrillation monitoring (especially in ablation patients), patients with infrequent but concerning symptoms and in stroke patients when the cause of the stroke has yet to be determined.
The loop recorder is implanted with the patient under local anesthesia. A small incision is made in the skin and the device is inserted in a pre-determined location. The small wound is closed with surgical glue. The patient can go home or back to work immediately.
All implantable devices (PPM, ICDs and loop recorders) have the capability to be remotely monitored. This means that the device can communicate with an external monitor and the external monitor can send the information securely to the physician’s office for analysis. The external monitors can be as small as a cell phone and some cell phones can be used as the external monitor. Generally, the communication occurs during sleeping hours to assure that the device can be accessed. The patient doesn’t have to do anything to initiate the communication other than initially activate the monitor and be in the vicinity of the monitor during sleeping hours.
Remote monitoring is especially useful for ICD patients as all abnormal rhythms can be sent to the office remotely. If the patient receives device therapy, the physician can analyze the recording of the therapy remotely. This may mean a quicker evaluation of the potential problem and faster decision making for treatment.
Remote monitoring for pacemakers is useful in order to understand potential rhythm problems and device function. Abnormal heart rhythms can be detected and recorded by the pacemaker. This information can be sent to the office well before the patient would ever be scheduled to be seen allowing for the potential of quicker and more comprehensive treatment. Monitoring pacemakers can allow for fewer office visits if the device is functioning appropriately and there is adequate battery longevity.
Remote monitoring for loop recorders provides immediate access for the physician to analyze, evaluate and treat the symptoms. In ablation patients, this type of monitoring can be important when determining if further treatment is needed. For stroke patients, detecting an atrial fibrillation can help prevent future strokes.