Case Studies
Overview
The following case studies showcase Reveal® DX and Reveal XT Insertable Cardiac Monitors’ various applications and outcomes.
Case Study 1: Syncopal Fall and Bradycardia Followed by Sinus Arrest
Case Study 2: Silent AF Burden
Case Study 3: AF with No Previous Cardiac Disease
Case Study 1
Syncopal Fall and Bradycardia Followed by Sinus Arrest
Background
An 83-year-old woman presented at the ER following her first syncopal event. During the event, the patient fell against a radiator in her home. An examination showed:
- Third degree burns to her upper extremities
- Tendon damage to her right hand
Her history revealed:
- Significant hypothyroidism
- Angina upon exertion
- 40% carotid stenosis on the right side
The patient’s workup for syncope included numerous diagnostic tests. However, all studies proved to be non-diagnostic and she was released from the hospital after recuperating from her burns.
Over the next two years, the patient continued to experience additional unexplained syncopal episodes. Her syncope:
- Threatened her independence
- Forced the family to consider moving her to an elder care facility
To avoid moving to an elder care facility, they began an aggressive search for a diagnosis.
Workup
While seeing an electrophysiciologist, the patient underwent extensive testing including:
- Holter monitor
- ECGs
- Echo
- Reveal® ICM inserted
Conclusion
Within six months the Reveal recorded an episode that yielded a diagnosis:
- The ECG from the Reveal showed a marked slowing in the heart rate, followed by eight seconds of sinus arrest (as shown below)
Reveal ECG
- A pacemaker was implanted
- The patient continues to live independently
Source: University of Western Ontario University Hospital, London, Ontario, Canada
Data on file at Medtronic, Inc. Results may not be typical for every patient.
Case Study 2
Silent AF Burden
Patient History
- 80-year-old male with history of mild stroke, AF, and syncope
- Three hospital visits in 5 years, between first syncope episode and Reveal® XT ICM insertion
Numerous Diagnostic Tests – All Inconclusive
- Holter monitor: seven occasions
- Carotid sinus massage: normal
- Tilt table test: positive
- EP study:
- Confirmed asymptomatic AF
- Patient cardioverted to normal sinus rhythm
- Subsequent negative EP study results
Outcome
- Reveal XT ICM inserted
- 44.9% silent AF burden documented
- Medications possibly contributing to AF altered
- Antiarrhythmic dosage adjusted
- Reveal XT ICM continues to monitor medication efficacy
Programmed parameters at insertion
Quick Look™ Screen at 1-Week Follow-Up
- Reveal XT ICM documented 14 episodes of true AF
- 44.9% AF burden
- Patient asymptomatic throughout
- All detected events automatically recorded
Quick Look screen documents AF burden percentage.
Episode Detail
- Type, Date/Time, Duration, and Rates recorded
Episode detail provides type, date/time, duration and rates recorded.
Markers detail when AF is detected and recorded.
Courtesy of Cardiology Associates, Cincinnati, OH.
Data on file at Medtronic, Inc. Results may not be typical for every patient.
Case Study 3
AF with No Previous Cardiac Disease
Relevant Patient History
- 52-year-old male with history of syncope and no previous cardiac disease
Numerous Diagnostic Tests – All Inconclusive Outcome
- Holter monitors: two occasions
- Tilt table test: negative
- Stress test: negative
Outcome
- Reveal® XT ICM inserted
- Two AF and one VT episodes recorded
- ~ 3.1% AF burden documented
- Antiarrhythmic medication prescribed
- No subsequent syncopal episodes
50 Days Post-Insertion: Cardiac Compass® Report
- Reveal XT ICM documented two AF episodes and one VT episode
- Percent of total time in AF: ~3.1%
Cardiac Compass Report details percent of time in AF.
First episode detail shows the total duration of AF.
Second episode detail shows the total duration of AF.
Third episode shows SVT.
Courtesy of University of Toledo, Toledo, OH.
Data on file at Medtronic, Inc. Results may not be typical for every patient.
