Clinical Guidelines and Indications
Reveal ICM Indications
The Reveal XT and Reveal DX Insertable Cardiac Monitors are insertable patient-activated and automatically-activated monitoring systems that record subcutaneous ECG and are indicated for:
- Patients with clinical syndromes or situations at increased risk of cardiac arrhythmias
- Patients who experience transient symptoms such as dizziness, palpitation, syncope, and chest pain that may suggest a cardiac arrhythmia
ACC/AHA Guidelines: Indications for Ambulatory Electrocardiography
Class I
Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective.
- Patients with unexplained syncope, near syncope, or episodic dizziness in whom the cause is not obvious.
- Patients with unexplained recurring palpitation.
Newer insertable cardiac monitors can be implanted under the skin for long-term recordings, which may be particularly useful for patients with infrequent symptoms.1,2
Class II
Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Class IIb: Usefulness/efficacy is less well-established by evidence/opinion.
- Patients with episodic shortness of breath, chest pain, or fatigue that is not otherwise explained.
- Patients with neurological events when transient atrial fibrillation or flutter is suspected.
- Patients with symptoms such as syncope, near syncope, episodic dizziness, or palpitation in whom a probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause.
References
- Strickberger SA, Benson DW, Biaggioni I, et al. AHA/ACCF Scientific Statement on the Evaluation of Syncope. From the American Heart Association Councils and the American College of Cardiology Foundation: In Collaboration with the Heart Rhythm Society. Circulation. January 17, 2006;113(2):316-327.
- Brignole M, Alboni P, Benditt DG, et al. Guidelines on management (diagnosis and treatment) of syncope – update 2004. Europace. November 2004;6(6):467-537.
ESC Guidelines: Diagnosis and Management of Syncope (2009)
Class I
Insertable loop recorder (insertable cardiac monitor) is indicated in:
- An early phase of evaluation in patients with recurrent syncope of uncertain origin, absence of high risk criteria, and a high likelihood of recurrence within battery longevity of the device
- High risk patients in whom a comprehensive evaluation did not demonstrate a cause of syncope or lead to a specific treatment
Class IIa
Insertable loop recorder (insertable cardiac monitor) should be considered to assess the contribution of bradycardia before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.
ESC Guidelines: Proposed Care Pathway1
Reference
- Moya et al. Guidelines for the diagnosis and management of syncope (Version 2009). European Heart Journal. Presented at ESC 2009.
