A UK cardiologist has become the first in the country to implant a hairpin-thin wireless heart monitor that routinely updates doctors on a patient's status.
The Reveal LINQ device, engineered by Hertfordshire-based company Medtronic and designed to investigate irregular heartbeats and blackouts, is a significant step up from its predecessor, another loop recorder about the size of a USB stick that required more time for implantation and could only be checked in a doctor's office. "It is about one tenth the size of the old device and how it's implanted benefits the patients," Nick Linker, who carried out the first trial at James Cook University Hospital in Middlesbrough, told us. "Originally it would take place in the operating theatre, with the patient being prepped, draped, a surgical incision etc. It takes about half an hour. The new system is much easier to implant.
You just need a local anesthetic and it has a pre-built insertion blade -- you press into skin and place the loop recorder into the hole you make, then close the skin with glue. It takes five minutes." In fairness, according to a NHS leaflet on the procedure, the wound can be closed with one stitch after the larger device is implanted. But the patient has to wait around for two to three hours afterwards.
Seeing as the device, which will last three years, is so much smaller, Linker says it's also a far better cosmetic result. "It's less uncomfortable and hardly noticeable under skin. The bigger one is a fairly obvious lump under the skin. On the patient yesterday it was so small, it was almost invisible."
The cardiologist foresees a day when the implantation will be done as an outpatient procedure in the "near future".
This could be of huge advantage, because practitioners currently might be reluctant to book a patient in for a surgical procedure unless absolutely necessary.
A loop recorder is recommended for anyone suffering from unexplained blackouts. Linker explains there are commonly two reasons for repeatedly suffering from blackouts -- either there's a problem in the brain or a problem with the heart, causing blood flow to the brain to stop (a common condition behind this is atrial fibrillation, which effects 800,000 in the UK). "The problem is difficult to catch," says Linker. "It's unpredictable and someone can go weeks or months without episodes. Because the device is recording all the time, we can view the heart rhythm at the time of symptoms."
European guidelines state that a loop recorder should be implanted in these instances, to save on costly tests and investigations and diagnose faster. But Linker says that in practice, this does not always happen. "What tends to happen is investigations are carried out and more tests are done -- the average number of tests even if the implant is placed early is six to eight tests." Waiting lists would be rendered irrelevant if it becomes an outpatient procedure.
Previously, readings could only be taken at a doctor's surgery, with the patient exposed to a device that connects with the loop recorder through the skin. Otherwise a "patient activator" could be used at home continuously or manually, but would need to be taken in to the doctor's. The new device is wireless and every user is given a 3G enabled box they can place by their bed at home. It will constantly interrogate the device and upload the data to the internet, sending any abnormal rhythms securely and directly to the hospital where the doctor can view it on a dedicated website.
Linker works at a department that specialises in implanting loop recorders and says they carry out about two or three procedures a week. According to Medtrionic, around 6,500 are expected to be installed in the first year.
The patient that received the first implant is a 60-year-old man suffering from an irregular heartbeat. As well as monitoring for the type of condition behind this, the loop recorder will also be able to track exactly how the patient responds to different treatments. "For 50 percent of people with atrial fibrillation there are no symptoms that suggest that they may have an arrhythmia," chief executive and founder of the Arrhythmia Alliance Trudie Lobban said in a statement. "While we are fortunate that there are a number of treatments and interventions for treating these conditions, the problem is finding those patients before they arrive at the hospital with a life threatening condition."
This article was originally published by WIRED UK
