Information & Advice For Arrhythmia Patients
Heart Rhythm Monitoring
Approaching 100,000 people in the UK die each year as a result of a treatable but undetected heart rhythm disorder. This highlights the vital importance of effective diagnosis. Even routine manual pulse checks can detect many arrhythmias for diagnostic testing.
Monitoring of the heart’s rhythm is the cornerstone of the diagnosis of cardiac arrhythmias. This is achieved in various ways, and also under different conditions where a clinician will attempt to replicate symptoms, reveal a hidden arrhythmia and correlate arrhythmias with specific events. In heart rhythm testing, the electrical activity of your heart is recorded to identify problems. Common heart monitoring techniques include:
- Electrocardiogram (ECG or EKG)
- Holter monitor (24h monitoring for days at a time)
- Implantable loop recorders (months of continuous monitoring)
In recent years, new technologies have also been developed to support patients who wish to monitor their heart rhythm and share results with their doctor. Contact us for more information.
Over the years, the ECG has been developed to become one of the most important tests in the investigation of heart-related problems. It can help a doctor understand the possible role of the heart in a person’s symptoms or problem.
If you are suffering with unexplained blackouts or a related condition, then your specialist or doctor may ask for this test. Every patient presenting with blackouts should undergo an ECG. A resting ECG is an important test as it may help to rule out many underlying heart conditions.
The test is painless and harmless, recording electrical impulses that come from your heart. At no point does this put electricity into your body, or cause any side effects.
An ECG test takes about five minutes. Electrodes (small sticky pads) are attached to your arms, legs and chest and the wires lead to the ECG machine. The machine can then read what is happening to your heart and record the information onto paper.
Through the different electrodes, the ECG gives 12 different electrical pictures of the heart. For this reason it is often also called a ‘12 lead ECG’. The ECG will tell the specialist whether your heart rate is too fast, too slow or irregular.
It is common to have more than one ECG recorded while being investigated for blackouts. This gives individual clinicians a chance to review a fresh test to give their own opinion on the heart trace. This can also help if the trace changes over time.
If your symptoms ‘come and go’ your doctor might suggest a Holter Monitor test, which is a continuous ECG recoding over approximately 24 hours.
Again, electrodes will be placed on your body, and this time they will be taped down. During a Holter Monitor test the wires will be attached to a smaller, portable device which can be strapped to the chest. After the specified time period the monitor can be returned to your doctor to see whether any arrhythmias have been indicated.
Insertable cardiac monitor (ICM)
Miniature Insertable Cardiac Monitor (ICM) System
If a doctor is unable to diagnose the cause of your symptoms with simple recording methods such as an ECG or a 24-hour monitor, they may consider an insertable cardiac monitor (ICM).
Traditionally doctors would have implanted an insertable loop recorder (ILR) (which is the size of a USB stick) under the skin on the left side of a patient’s chest in order to capture a recording of the heart rate and rhythm at the time of an episode.
The device records on a continuous loop for up to three years. If you experience palpitations or breathlessness, a separate device would be used to freeze the recording and document the episode which would then be assessed by a heart rhythm specialist.
The miniature insertable cardiac monitor (ICM system)
The ICM is a diagnostic tool that will monitor the heart’s electrical activity and help a heart rhythm specialist identify the cause of your symptoms. This device offers the same benefits as a traditional ILR but is a tenth of the size. Virtually invisible to the naked eye, it is more comfortable and much less noticeable under the skin.
How is the ICM fitted?
As this miniature monitor is so much smaller and easier to implant, it is intended that the procedure could be performed in a treatment room rather than a theatre setting. Implant of the device requires an incision of less than 1cm which can then be closed very simply with medical adhesive, steri strips or one suture. It is anticipated the procedure will take about ten minutes.
Hopefully this will reduce the waiting lists for this diagnostic device to be fitted and in some cases the procedure could be undertaken when you first attend the clinic, saving delay in reaching a diagnosis and the inconvenience of repeat visits.
How is an episode captured?
There would be no need to use a separate device to record an episode as the ICM is remotely monitored, wirelessly, through a receiver in your house. Any unusual heart activity will be transmitted via a 3G signal to a secure system which will alert the heart rhythm specialist. You would then be contacted if necessary. Inevitably this will provide more peace of mind for a patient.
Removal of the ICM
Once the reason for your heart rhythm problems has been identified through this monitor the device can be removed with another simple procedure.