Device Diagnostics
Implantable cardiac device diagnostics help early detection and treatment. Medtronic offers a variety of device diagnostics in an easy to read format accessible both in-clinic and remotely.
Comprehensive Diagnostic Reports to Assess Clinical Status
Cardiac Compass Report
Detail - Cardiac Compass Trends Help Clinicians Assess the Condition of Patients with Implantable Cardiac Rhythm Devices
Cardiac Compass® Trends and Heart Failure Management Reports offer a multidimensional perspective of patients’ clinical status.
This suite of trends provides clinicians another set of tools to help guide therapy decisions and identify clinical issues early, so as to intervene.
14 Months of Trended Data
- Insertable cardiac monitor provides trended data that can help assess need for medication, cardioversion or other rate or rhythm control therapy
- Pacemaker, ICD and CRT-P and CRT-D trended data helps you evaluate arrhythmia treatment efficacy
- Aids assessment of device therapy and drug titration
- Facilitates management of disease progression
- Identifies asymptomatic arrhythmias
Detail - Rate Histograms Help Clinicians Assess the Condition of Patients with Implantable Cardiac Rhythm Devices.
Detail - Detailed EGM™ Viewer Displays Symptomatic Episodes to Aid in the Assessment of the Patient’s Condition
Rate Histograms
Before and Since Last Visit histograms provide unique additional insight.
Detailed EGM Viewer
Detailed EGM™ Viewer* displays symptomatic episodes to aid in your assessment of the patient’s condition.
Patient-activated EGM storage is accessed remotely on the Medtronic CareLink® Network.
* Detailed EGM Viewer is a feature in select Medtronic devices.
Cardiac Monitoring
One of the most difficult arrhythmias to manage is AT/AF. Successful management requires patient monitoring to understand the amount of AT/AF burden the patient is experiencing. With this information, physicians may properly manage a patient’s need for:
- Medication
- Cardioversion
- Other rate or rhythm control therapy
Cardiac Compass Reports provide:
- 14 months of rhythm data, including accurate daily AF burden measurement*
- Ventricular rate during AT/AF
- Heart rate variability
- Average day and night rates
REVEAL® XT Insertable Cardiac Monitor Cardiac Compass Report
AT/AF Summary:
- Provides duration and episode start time details
Reports can be accessed via:
* Accurate = true daily burden > 10 minutes: AF burden accurate in 92% of patients. True daily burden ≤ 10 minutes: absence of AF appropriately detected in 96% of patients.
Simple Follow-Up for Clinicians
Detail - Pacemaker Cardiac Compass Report
Medtronic pacemakers provide a variety of easy to use diagnostics to help clinicians assess a patient’s condition.
- Quick Look™ II screen
- TherapyGuide™ feature
- Cardiac Compass Report
- AT/AT therapy options
Detail - Quick Look II Screen – all key information on one screen
Quick Look II Screen – All Key Information on One Screen
- Routine follow-up measurements are done for you
- All measurements are automatic and displayed upon initial interrogation
Detail - TherapyGuide feature simplifies and tailors programming by providing suggested device settings
TherapyGuide Feature – Tailored, Clinically Oriented Programming Using Physician Selected Parameters
TherapyGuide simplifies and tailors programming by providing suggested device settings based on physician-selected patient conditions.
Cardiac Compass Trends
Concise information to:
- Identify atrial arrhythmias
- Make key therapy decisions (eg, titrating medications)
- Monitor results of therapy changes
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Detail - Assess Rhythm Control | Detail - Assess Rate Control | Detail - Assess Rate Control following change in pharmacologic therapy |
Medtronic Cardiac Compass Report
Detail - Heart Failure Management Report with OptiVol trends
Offers Comprehensive Understanding of the Patient’s Heart Failure Status
For clinicians, the challenge is identifying and managing those patients at risk for decompensation and the resulting hospitalization. The Medtronic Cardiac Compass® Report with OptiVol® Fluid Status Monitoring provides the industry’s most comprehensive heart failure diagnostics, offering clinicians another set of tools to help guide decisions.
- Objective insight into physiological status
- 10 easy-to-read temporally aligned trends
- Continuous data, regardless of patient compliance
- Industry exclusive OptiVol Fluid Status Monitoring
- AF Burden trends that fully disclose all episodes
- Ventricular Rate trending during Atrial Fibrillation
Detail - Heart Failure Management Report/Cardiac Compass Report
Medtronic Cardiac Compass/Heart Failure Management Report
The Cardiac Compass/Heart Failure Management Report provides:
- OptiVol Fluid Status Monitoring
- AT/AF Burden
- Ventricular Rate during AT/AF
- Patient Activity
- Average Ventricular Rate (day/night)
- Heart Rate Variability
- Percent Pacing per Day (A/V)
- VT/VF Episode Information
Clinical Application of the HF Diagnostic Trends (PDF, 684 KB)
Rate Histograms Are Also Available
Histograms include information prior to and since last session for easy comparison.
The Rate Histograms Report includes:
- Atrial rate
- Ventricular rate
- Ventricular rate during AT/AF histograms
Diagnostic Data Access
- CardioSight® Reader for in clinic data access for heart failure specialists
- Medtronic CareLink® Programmer for in-clinic data access
CardioSight Reader for In-Clinic Access to Heart Failure Management Report
CareLink Programmer for Data Access and Device Interrogation Data
Clinical Support for Diagnostic Trends
Detail - OptiVol Fluid Status Monitoring
OptiVol Fluid Status Monitoring – Thoracic Impedance Trend
The Thoracic Impedance Trend plots the daily averages of the patient’s raw intrathoracic impedance against the reference trend. It is an accurate representation of the patient’s impedance status.
- Intrathoracic impedance is inversely correlated with pulmonary capillary wedge pressure, fluid balance, and NT-proBNP1,2
- In the weeks leading up to a hospitalization for worsening heart failure, intrathoracic impedance decreases in advance of signs and symptoms1
OptiVol Fluid Index Trend
- The OptiVol Fluid Index quantifies the spread between the daily averages and the reference trend. It is a graphical representation of the accumulation of consecutive day-to-day differences between the Daily and Reference impedance
- Each OptiVol threshold crossing is associated with increased risk of worsening heart failure3
- OptiVol Monitoring is not intended to replace assessments which are part of standard clinical practice
AT/AF Burden
AT/AF Burden
The atrial tachycardia/atrial fibrillation burden trend plots the total time spent in AT/AF on a daily basis.
- Atrial tachyarrhythmia episodes are often asymptomatic and symptoms commonly attributed to AF are poorly associated with atrial tachyarrhythmias5
- Intermittent and symptom based monitoring strategies fail to accurately identify the occurrence of AT/AF episodes or quantify burden6
- AT/AF episodes lasting longer than 1 day are independently associated with embolic events7
Ventricular Rate during AT/AF
Ventricular Rate During AT/AF
This trend displays the daily average and maximum ventricular rates occurring during AT/AF.
- Poor rate control with atrial tachyarrhythmias is associated with earlier time to first hospitalization8,9
- Poor rate control is the leading reason for inappropriate ICD shocks10 and reduced CRT pacing11
Patient Activity
Patient Activity Hours/Day
The device accelerometer accumulates the number of activity counts sensed each minute. A minute is considered active if the counts exceed a threshold equal to walking approximately 70 steps per minute. The graph displays the total time active per day.
- Activity level measured by an implantable cardiac device decreases significantly in the days leading up to a heart failure hospitalization12
- Increased activity levels measured by an implantable device are correlated with an improvement in the patient’s heart failure status13
Average Ventricular Rate (Day/Night)
Average Ventricular Rate (day/night)
The daily average night (12 am – 4 am) and day (8 am – 8 pm) heart rate are trended on this graph.
- Improved chronic HR profile reflects response to CRT therapy14
- Day and night resting heart rates increase and the difference between them narrows with worsening HF15
Heart Rate Variability
Heart Rate Variability
The median atrial heart rate is determined every 5 minutes and a variability value is plotted each day. HRV is not computed if > 80% of the time is pacing or AT/AF.
- Low HRV (< 50 ms) is associated with increased risk for heart failure hospitalizations and mortality. Conversely, patients with HRV (> 100 ms) are at significantly lower risk12
- Decreasing HRV may be observed up to 3 weeks in advance of a heart failure hospitalization utilizing an implantable device12
Percent Pacing per Day
Percent Pacing Per Day (A/V)
The Percent Pacing Per Day trend provides a view of pacing over time; it displays the daily percentage of atrial and ventricular pacing.
- Information regarding percentage of ventricular pacing is important for maximizing CRT, especially in patients with AF where poor rate control can compromise CRT and therapies11,16
- Management of right ventricular pacing in patients with compromised ventricular function and heart failure is an important strategy to reduce heart failure hospitalizations17,18
One or More Shocks per Day
One or More Shocks per Day
This trend displays an annotation for the day on which a defibrillation therapy, cardioversion therapy, or atrial shock therapy was delivered.
Treated VT/VF Episodes per Day
Treated VT/VF Episodes per Day
This trend provides a history of ventricular tachyarrhythmias. The device records the total number of spontaneous VT and VF episodes each day.
References
- Abraham W, Foreman B, Fishel R, Hass G, Moe B. Fluid accumulation status trial (FAST). Heart Rhythm. May 2005;2(5):S65-S66.
- Lüthje L, Vollmann D, Drescher T, et al. Intrathoracic impedance monitoring to detect chronic heart failure deterioration: relationship to changes in NT-proBNP. Eur J Heart Fail. June-July 2007;9(6-7):716-722.
- Whellan DJ, Al-Khatib SM, Kloosterman EM, et al. Changes in intrathoracic fluid index predict subsequent adverse events: results of the multi-site Program to Access and ReviewTrending INformation and Evaluate CoRrelation to Symptoms in Patients with Heart Failure (PARTNERS HF) Trial. J Card Fail. November 6, 2008;14(9):799.
- Germany R, et al. Acute changes in intrathoracic impedance are associated with increased risk of heart failure hospitalization. Heart Rhythm. May 2008;5(suppl): (PO6-84) S388.
- Strickberger SA, Ip J, Saksena S, Curry K, Bahnson TD, Ziegler PD. Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm. February 2005;2(2):125-131.
- Ziegler PD, Koehler JL, Mehra R. Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm. December 2006;3(12):1445-1452.
- Capucci A, Santini M, Padeletti L, et al. Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers. J Am Coll Cardiol. November 15, 2005;46(10):1913-1920.
- Ousdigian KT, Johnson WB, Koehler JL, Wilkoff BL. Very poor rate control during atrial tachyarrhythmias predicts cardiovascular hospitalizations. J Card Fail. August 2006;12(6)(suppl 1):S57-S58.
- Willems R, Morck ML, Exner DV, Rose SM, Gillis AM. Ventricular high-rate episodes in pacemaker diagnostics identify a high-risk subgroup of patients with tachy-brady syndrome. Heart Rhythm. October 2004;1(4):414-421.
- Dorian P, Philippon F, Thibault B, et al, for the ASTRID Investigators. Randomized controlled study of detection enhancements versus rate-only detection to prevent inappropriate therapy in a dual-chamber implantable cardioverter-defibrillator. Heart Rhythm. November 2004;1(5):540-547.
- Ousdigian KT, Thompson D, Qi D, et al. A single day of AF with poor rate control predicts a subsequent week of reduced CRT. [abstract PO6-68]. Heart Rhythm. 2007;4(Suppl 5S): S379.
- Adamson PB, Smith AL, Abraham WT, et al. Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device. Circulation. October 19, 2004;110(16):2389-2394.
- Braunschweig F, Mortensen PT, Gras D, et al. Monitoring of physical activity and heart rate variability in patients with chronic heart failure using cardiac resynchronization devices. Am J Cardiol. May 1, 2005;95(9):1104-1107.
- Fantoni C, Raffa S, Regoli F, et al. Cardiac resynchronization therapy improves heart rate profile and heart rate variability of patients with moderate to severe heart failure. J Am Coll Cardiol. November 15, 2005;46(10):1875-1882.
- Casolo GC, Stroder P, Sulla A, Chelucci A, Freni A, Zerauschek M. Heart rate variability and functional severity of congestive heart failure secondary to coronary artery disease. Eur Heart J. March 1995;16(3):360-367.
- Gasparini M, Auricchio A, Regoli F, et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol. August 15, 2006;48(4):734-743.
- Sweeney MO, Hellkamp AS. Heart failure during cardiac pacing. Circulation. May 2, 2006;113(17):2082–2088.
- Smit MD, Van Dessel PF, Nieuwland W, et al. Right ventricular pacing and the risk of heart failure in implantable cardioverter-defibrillator patients. Heart Rhythm. December 2006; 3(12):1397-1403.
Medtronic Cardiac Compass Report
Detail - CRT-P Cardiac Compass Report
Offers Comprehensive Understanding of the Patient's Heart Failure Status
For clinicians, the Medtronic Cardiac Compass® Report provides comprehensive heart failure diagnostics, offering clinicians another set of tools to help guide decisions.
Diagnostic Data Access
- CardioSight® Reader for in clinic data access for heart failure specialists
- Medtronic CareLink® Programmer for in-clinic data access
CardioSight Reader for In-Clinic Access to Heart Failure Management Report
CareLink Programmer for Data Access and Device Interrogation Data