When a patient is fitted with an insertable cardiac monitor (ICM), it's important to do a follow-up within four to six weeks in order to check on the insertion sites and address the patient's questions. In this video, from our Insertable Cardiac Monitoring Essentials course, we'll cover the process of downloading data from an ICM device and ensuring that the device is sensing waves accurately.
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Arrhythmias can be difficult to detect. Insertable cardiac monitors (ICMs) can spot rhythm problems when other devices can’t. In our Insertable Cardiac Monitoring Essentials course, you’ll learn about the indications for an ICM implant, the different types of ICMs available, and the techniques used to insert and explant these devices. You’ll also cover data download methods, troubleshooting, and how to make the most out of your ICM devices.
It's generally good practice to arrange for a face to face office visit around four to six weeks post ICM implant to check on the insertion site and to address any issues or questions that a patient may have. To download data from an ICM at an office visit a standard device program it can be used in the same way that you might interrogate a permanent pacemaker. To interrogate an ICM using a programmer, place a programmer head over the device and follow the on-screen instructions once the device has been identified.
The programmer can be used to download ECG recordings, and also to change settings on the device to optimize its function. Some manufacturers also support device interrogation and programming via a tablet-based application. An example of this is Medtronic's Reveal LINQ mobile manager, which allows you to communicate with the ICM device without having to use a traditional programmer.
The application allows you to select the initial parameters when you insert a reveal link device, or to check the device parameters, and also download ECG recordings on a follow up visit. Whether you use a programmer or a tablet based application, you can check the ECG quality and then sure that the ICM device is sensing waves correctly.
But device will not only display the patient's ECG, but it will also flag up those complexes where it has identified ventricular sensing (VS) events. In this way, you can check but all of a patient's ventricular complexes have been identified correctly. You can download and review any ECG recordings that be made either as auto detections by the device itself, or as patient activated recordings.
In this example, you can see that the ICM device has saved an ECG recording showing an irregular rhythm with chaotic atrial activity. This is an episode of atrial fibrillation that the ICM device has correctly identified, automatically saving the CG for subsequent review by the clinician. Don't forget to check the device's battery status to ensure that the ICM has sufficient battery longevity to last until the next scheduled review visit.
At each device review, you can adjust the recording parameters according to requirements, you should aim to make the best use of the available device storage to maximize the chances of capturing the data that you need. You can set the type of arrhythmia events or device will detect and the upper and lower limits for the heart rate that will be detected as tachy or brad" episodes.
You can also determine how long an episode has to last for before the device will recognize it as an event. You can set how long patient activated recordings will last for and once you're happy, you can save all of these settings to be ICM device. Remember that each manufacturer's ICM device will be slightly different. So it's important to familiarize yourself with a relevant manual for the device that you will be using.