Using ICMs in Clinical Practice to Manage Afib and Syncope

Solomon J. Sager, MD: How do I use insertable cardiac monitors in my practice? I’ve been using insertable cardiac monitors in my practice for 8 years. Over the past 3 years, we’ve been implanting them in our office at Chicago Cardiology Institute. We were 1 of the first in the city of Chicago, Illinois to implant insertable cardiac monitors in the office, and we have robust practice in this regard. I use them frequently for my patients with A-Fib [atrial fibrillation]. I find them to be a powerful tool to help guide my decision-making with regard to patient care. I take pride in treating each patient as an individual, and I try to tailor the therapy that they may need based on their individual needs and their individual circumstances. The data that I collect from insertable cardiac monitors allows me to do this for my patients.

The vast majority of patients are extremely happy with insertable cardiac monitors as a tool. They like to know that we’re watching over them and collecting data on their heart rhythm, and they like that we can use that data at the point of care in the office and show them exactly how much A-Fib they’re having, when they had it, when it started, when it stopped, if it’s worse than before, if it’s better than before, and how they’ve done since their ablation. All these things are powerful tools that help guide decision-making that they’re very content and satisfied with.

For syncope, which is the second most common reason that I implanted insertable cardiac monitors, patients are very happy that they’re able to be watched for possible high risk or life-threatening arrhythmias that may be causing them to pass out. There are tons of great stories that I have about patients who had undetected arrhythmias, even undetected ventricular arrhythmias that required defibrillators, where we save their life by using the data collected from an insertable cardiac monitor. Another diagnosis I use them for are cryptogenic stroke. It’s a powerful tool to detect A-Fib and help prevent recurrent strokes in patients who’ve had them as well as unexplained palpitations and monitoring for ventricular arrhythmias. It’s probably not used enough for monitoring ventricular arrhythmias, but we have a lot of patients who have nonsustained ventricular tachycardia. And we know they’re at risk for the development of sustained arrhythmias, although they don’t necessarily meet criteria for implantable cardioverter defibrillators. The insertable cardiac monitor can be a powerful tool for those patients to monitor them and to determine their risk.

Thank you again for tuning into Practical Cardiology™and listening to this talk on insertable cardiac monitors. We appreciate your support. I have some final thoughts on insertable cardiac monitors. Insertable cardiac monitors, in my opinion, are a powerful tool and an underutilized tool for patients with heart arrhythmia. They allow for powerful data collection to help take care of each patient on an individual basis. The future is bright for insertable cardiac monitors, and we still haven’t figured out the best way to use them. The data we collect leads to important clinical decision-making regarding catheter ablation, antiarrhythmic therapy, diagnosing patient symptoms, and even anticoagulation treatment in some individual circumstances. At some point, we may be using the amount of A-Fib the patients have to guide us in our medical decision-making and potentially in regard to anticoagulation for some lower- to intermediate-risk patients.

Transcript Edited for Clarity