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Ejectable loop recorders?
Author’s Accepted Manuscript Ejectable loop recorders? Hariharan Sugumar, Matthew Tung, Christopher Lane, Laurence D Sterns, Paul G Novak, Richard Leather www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1547-5271(16)30375-7 http://dx.doi.org/10.1016/j.hrthm.2016.05.027 HRTHM6731
To appear in: Heart Rhythm Received date: 16 May 2016 Cite this article as: Hariharan Sugumar, Matthew Tung, Christopher Lane, Laurence D Sterns, Paul G Novak and Richard Leather, Ejectable loop recorders?, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2016.05.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Ejectable loop recorders? Short-title: Missing LINQ Hariharan Sugumar 1,2 MBBS,BMedSci Matthew Tung 1,2 MBBS Christopher Lane 1,2 MD Laurence D Sterns 1,2 MD,FHRS Paul G Novak 1,2 MD Richard Leather 1,2 MD 1:RoyalJubileeHospital, 1952 Bay street, Victoria BC, Canada V8R1J8 2:VictoriaCardiacArrhythmiaTrials, 301–740 Hillside Ave, Victoria BC, Canada V8T1Z4 Corresponding author: Hariharan Sugumar +12508132971
Conflict of interest: None for Hariharan Sugumar, Matthew Tung, Christopher Lane, Laurence D Sterns, Paul G Novak and Richard Leather Keywords: Loop recorders; migration; spontaneous explant; late complication; implantable cardiac monitors; reveal LINQ
“Search for the missing LINQ” A 69y.o man with atrial fibrillation(AF) was implanted with a Reveal LINQTM injectable loop recorder (ILR) prior to pulmonary vein isolation for assessment of AF burden. (Figure 1A). Recovery post implantation was unremarkable. Ten weeks after implant, and four weeks after ablation, the patient activator, which had no difficulty with daily communication with the LINQ device, suddenly ceased communicating and the MyCarelinkTM home monitor abruptly stopped transmitting scheduled daily reports. The patient denied any trauma, signs of infection or erosion at the implant site. He did admit to a trace amount of spontaneous blood at the insertion site on one day only approximately two weeks after implant. On examination the site appeared well healed with the ILR unable to be palpated. Attempts to locate the device by scanning the anterior chest wall with the programmer wand was unsuccessful. A chest X-ray (Figure 1B) confirmed that the device was no longer present at the implant site. Fluoroscopy was performed to confirm that the device had not migrated along the tissue plane elsewhere over the chest, axilla or abdomen.
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Early spontaneous device extrusion has been reported once in a prospective trial reported by Mittal et al 1 but late migration or undetected extrusion has not been reported. This case of spontaneous external device migration raises the question of whether current recommendations to not formally secure skin closure should be revisited. Due to their slim profile it is plausible that migration and extrusion can occur relatively innocuously leading to unexpected loss of monitoring via the ILR. In the absence of remote monitoring this could be undetected for up to 6 months given the current recommendations in place for ambulatory ILR follow up 1.
Mittal S, Sanders P, Pokushalov E, Dekker L, Kereiakes D, Schloss EJ, Pouliot E, Franco N, Zhong YAN, Di Bacco M, PÜRerfellner H. Safety Profile of a Miniaturized Insertable Cardiac Monitor: Results from Two Prospective Trials. Pacing and Clinical Electrophysiology 2015;38:1464-1469.
Figure 1A(left). CXR post implant; B(right). CXR of Missing LINQ
1
PII: DOI: Reference:
S1547-5271(16)30375-7 http://dx.doi.org/10.1016/j.hrthm.2016.05.027 HRTHM6731
To appear in: Heart Rhythm Received date: 16 May 2016 Cite this article as: Hariharan Sugumar, Matthew Tung, Christopher Lane, Laurence D Sterns, Paul G Novak and Richard Leather, Ejectable loop recorders?, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2016.05.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Ejectable loop recorders? Short-title: Missing LINQ Hariharan Sugumar 1,2 MBBS,BMedSci Matthew Tung 1,2 MBBS Christopher Lane 1,2 MD Laurence D Sterns 1,2 MD,FHRS Paul G Novak 1,2 MD Richard Leather 1,2 MD 1:RoyalJubileeHospital, 1952 Bay street, Victoria BC, Canada V8R1J8 2:VictoriaCardiacArrhythmiaTrials, 301–740 Hillside Ave, Victoria BC, Canada V8T1Z4 Corresponding author: Hariharan Sugumar +12508132971
Conflict of interest: None for Hariharan Sugumar, Matthew Tung, Christopher Lane, Laurence D Sterns, Paul G Novak and Richard Leather Keywords: Loop recorders; migration; spontaneous explant; late complication; implantable cardiac monitors; reveal LINQ
“Search for the missing LINQ” A 69y.o man with atrial fibrillation(AF) was implanted with a Reveal LINQTM injectable loop recorder (ILR) prior to pulmonary vein isolation for assessment of AF burden. (Figure 1A). Recovery post implantation was unremarkable. Ten weeks after implant, and four weeks after ablation, the patient activator, which had no difficulty with daily communication with the LINQ device, suddenly ceased communicating and the MyCarelinkTM home monitor abruptly stopped transmitting scheduled daily reports. The patient denied any trauma, signs of infection or erosion at the implant site. He did admit to a trace amount of spontaneous blood at the insertion site on one day only approximately two weeks after implant. On examination the site appeared well healed with the ILR unable to be palpated. Attempts to locate the device by scanning the anterior chest wall with the programmer wand was unsuccessful. A chest X-ray (Figure 1B) confirmed that the device was no longer present at the implant site. Fluoroscopy was performed to confirm that the device had not migrated along the tissue plane elsewhere over the chest, axilla or abdomen.
0
Early spontaneous device extrusion has been reported once in a prospective trial reported by Mittal et al 1 but late migration or undetected extrusion has not been reported. This case of spontaneous external device migration raises the question of whether current recommendations to not formally secure skin closure should be revisited. Due to their slim profile it is plausible that migration and extrusion can occur relatively innocuously leading to unexpected loss of monitoring via the ILR. In the absence of remote monitoring this could be undetected for up to 6 months given the current recommendations in place for ambulatory ILR follow up 1.
Mittal S, Sanders P, Pokushalov E, Dekker L, Kereiakes D, Schloss EJ, Pouliot E, Franco N, Zhong YAN, Di Bacco M, PÜRerfellner H. Safety Profile of a Miniaturized Insertable Cardiac Monitor: Results from Two Prospective Trials. Pacing and Clinical Electrophysiology 2015;38:1464-1469.
Figure 1A(left). CXR post implant; B(right). CXR of Missing LINQ
1