al monitoraggio mensile: indicazioni e risultati - …€¦ · dall’holter al monitoraggio...
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Dall’Holter al Monitoraggio Mensile: Indicazioni e Risultati Emanuela T. LOCATI, MD, PhD Ospedale Niguarda Dipartimento Cardiovascolare Cardiologia 3 – Elettrofisiologia MILAN, Italy
Sessione AIAC: Nuove Tecnologie in Aritmologia
M.A., Male, 74 yrs totally asyntomatic
during recording
Holter 72 hours
Asymptomatic FAP during Multiday Holter
CG-2206™ “Event Recorder” 30 sec
1-lead ECG
CG-7000™ 12-lead Standard ECG
CG-6106™ “Loop Recorder” 90 sec 1-lead ECG
First Generation Event and Loop Recorders with Transtelefonic Transmission
M.C. Female 75 yrsi
CAD AHT
Unexplained Palpitationis
CG2206 Event monitoring: PAF during palpitations
Optimal Duration of Monitoring
INCIDENZA CUMULATIVA DI EVENTI
94
41
144 4 7
2
0
20
40
60
80
100
1 2 3 4 5 6 7
SETTIMANE
SO
MM
A E
VE
NT
I
INCIDENZA DI EVENTI PER SOGGETTO
0
2
4
6
8
10
12
14
16
1 2 3 4 5 6 7
SETTIMANA
SO
MM
A E
VE
NT
I
TeCH Niguarda: Time to Onset of First Symptom
Low Risk
Frequency of syncope ≤ 4 weeks?
Arrhythmic cause?
no
yes
yes no
Further tests (Tilt Test,...)
Therapy to avoid further syncopes
Risk Stratification in low-risk patients (ESC2009)
Up to 30 days monitoring
3 Recording Modalities
ECG Strips up to 22.5 minutes
Auto-trigger (SFT®)
Hourly time table (SFA®/SFT®)
Patient activation (SFA®/SFT®)
Heart Rate Profile SFA®
SFT®
From External Loop Recorder to Extended Holter monitoring
Diagnostic yield for syncope/palpitation of SpiderFlash-T with autotrigger
function in symptomatic/asymptomatic patients
Diagnostic yield
60 second asystole
Female, 70 yrs Permanent AF, Hx of syncope 24 Holter negative for pauses
SpiderFlash-T Automatic & patient activation
Day 5
Syncope due to 60 sec asystole during chronic AF
Paper Speed 3.125 mm/sec
60 seconds asystole
Patient sent to Pacemaker implant! Day 5
SpiderFlash-T Automatic & patient activation
Syncope due to 60 sec asystole during chronic AF
Female, 70 yrs Permanent AF, Hx of syncope 24 Holter negative for pauses
Day 8
SpiderFlash-T Automatic & patient activation
6 sec Asystole During Nightmare in PAF
Male, 73 yrs PAF, Hx of syncope 24 Holter negative for pauses
Atrial fibrillation (paroxysmal or chronic) is not included among ECG features suggesting arrythmic syncope is ESC 2009 guidelines!
Male, 45 yrs, Hx of Recurrent Epysodes of Unexplained TLoC
Simil-Syncope due to Epilectic Seizure (during sleep)
Simil-Syncope due to Epilectic Seizure (during sleep)
Male, 45 yrs, Hx of Recurrent Epysodes of Unexplained TLoC
85% one-month diagnostic yield for unexplained palpitations
ECG findings in patients with a history of pre-syncope or palpitations
M.M. Female
16 yrs Palpitations,
Presyncope and Chest pain
Palpitation and presyncope due to fast PSVT
M.M. Female
16 yrs Palpitations,
Presyncope and Chest pain
Palpitation and Presyncope due to fast PSVT: Onset and Offset
SMART Study inlcuded 239 patients
FAP > 5 sec was detected in 29 patients (12%)
FAP > 30 sec was detected in 16 patients (6.7%)
Most events were asymptomatic
Stroke 2012; 43:2788
Wireless Sensor Device
• Wireless dynamic ECG can be used in real-time and holter
• Long-duration: 8 GB capacity (removable micro-SD
card, stores up to 2 months in continuous ECG
recording mode)
• ECG in environments with high levels of physical
activity, such as sports
Technical specifications ECG Channels: single-lead // Three-leads Sampling rate: 250 sps Bandwidth: 0.05-100 Hz Class: IIa Type: CF
Bluetooth® v2.0+EDR Class I (50 m) Accelerometer 3-axis HR transmitter (5.5 khz)
Data storage 8GB 54 gr
NUUBO: Wireless Long-Term Holter
BlendFix® Sensor Electrode Technology
• Proprietary biomedical e-textile technology (wearable sensor)
• Cost-effective, continuous and non-invasive
• Excellent ECG signal quality and dynamic control
• Extremely easy-to-use, minimal impact on patient lifestyle
• Available in different sizes .
NUUBO: Wireless Long-Term Holter
Patient sent to ICD implant!
AMG, Female
24 yrs Hx of
Palpitation at effort,
Sister with SD
NUUBO: Wireless Long-Term Holter
Now available new and different methods for long term ECG monitoring
Distintion between diagnostic and remote monitoring tools
More efficient electrodes system (belt or patch electrodes or vest or wireless non-contact
ECG electrodes) for long-term external ECG monitoring
Continuous long-term Holter ECG recording (>30 days) as first step in most cases
Insertable LR for very prolonged ECG monitoring in selected cases
Need of call-centers for telemetric surveillance of devices
Revision of Clinical Guidelines for management of AF, syncope and palpitations
Need of precise definition for asymptomatic atrial fibrillation (minimum duration?)
Need of reimbursement fee for long-term Holter ECG monitoring and Telecardiology !!!!!
Future of Long-Term ECG Monitoring
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