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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.
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*
* 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.
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
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
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
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
Graph of Patient Activity
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)
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
This trend provides a history of ventricular tachyarrhythmias. The device records the total number of spontaneous VT and VF episodes each day.
References
1
Abraham W, Foreman B, Fishel R, Hass G, Moe B. Fluid accumulation status trial (FAST). Heart Rhythm. May 2005;2(5):S65-S66.
2
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.
3
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.
4
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.
5
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.
6
Ziegler PD, Koehler JL, Mehra R. Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm. December 2006;3(12):1445-1452.
7
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.
8
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.
9
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.
10
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.
11
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.
12
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.
13
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.
14
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.
15
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.
16
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.
17
Sweeney MO, Hellkamp AS. Heart failure during cardiac pacing. Circulation. May 2, 2006;113(17):2082–2088.
18
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.
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
Clinical Application of the HF Diagnostic Trends (PDF, 684 KB)
