Initial Experience with the Reveal LINQ Insertable Cardiac Monitor
Case Description
Our patient is a 76-year-old woman with a history of hypertension and adult-onset diabetes.
New Insertable Cardiac Monitor
In February of this year, the FDA approved Medtronic’s subcutaneous insertable loop recorder, the Reveal LINQ cardiac monitor. Like its predecessor, the Reveal XT, the LINQ maintains a three-year battery life and the ability to detect atrial fibrillation. However, LINQ has a number of revolutionary advancements. This new device is 87% smaller (about one-third the size of a triple A battery) (Figure 2). Enhanced atrial fibrillation detection algorithms,
Discussion
Concerned that our patient could indeed have had atrial fibrillation as the source of her embolic stroke, I felt that continuous long-term monitoring was indicated in her case. On February 22, 2014, she underwent insertion of the LINQ monitor in one of the first implants in the United States. The implant procedure took only minutes, and she was discharged from the implant within about 10 minutes. A Steri-Strip was placed over the very small incision (less than half an inch). She required no sedation and only local anesthetic, describing no discomfort with the procedure. I received a Medtronic CareAlert notification 33 days after the implant; she had experienced a 10-hour episode of asymptomatic atrial fibrillation. Her treatment course was altered by placing her on oral anticoagulation. Given the CRYSTAL-AF data showing an average time to detect atrial fibrillation of 84 days (at the 12-month endpoint), her atrial fibrillation being found in 33 days was a much shorter time, but well beyond standard monitoring of 24-hour, 7-day or 30-day ambulatory monitoring.
The LINQ monitor comes preloaded in an insertion tool, which allows for a simple insertion procedure (Figure 4). Other supplies needed to perform the implant are minimal, consisting
As a clinician specializing in diagnosing, managing and treating heart rhythm disorders, the LINQ monitor is a tool that allows me to monitor patients for heart rhythm abnormalities on a continuous basis. Some of these patients may be at risk for stroke or recurrent stroke, syncope or sudden cardiac death. Patients with syncope due to a cardiac cause have a higher mortality.3 Implantable cardiac monitor use is supported by the most recent (2009) guidelines (Class 1 indication) in the evaluation of the syncope patient.4
Disclosure: The author has no conflicts of interest to report relative to the content herein. Outside the submitted work, Dr. Rogers reports consultancy, honoraria (as a speaker), payment for development of educational presentations including service on speakers’ bureau, and travel/accommodations expenses covered or reimbursed from Medtronic.
References
- Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41.
- Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719-2747.
- Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med. 2002;347(12):878-885.
- Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS), Moya A, Sutton R, Ammirati F, et al. Guidelines for the management and diagnosis of syncope (version 2009). Eur Heart J. 2009;30(21):2631-2671.