Implantable Biosensors and Future Role in Electrophysiology

Implantable loop recorders (ILR) are used for long-term arrhythmia monitoring inpatients that have had syncope or cryptogenic strokes (possible from atrial fibrillation).  There are two primary models of loop recorders: St. Jude Medical’s Confirm (http://www.sjmprofessional.com/Products/US/Implantable-Cardiac-Diagnostics/SJM-Confirm-Implantable-Cardiac-Monitor.aspx) and Medtronic’s Reveal (http://www.medtronic.com/for-healthcare-professionals/products-therapies/cardiac-rhythm/cardiac-monitors-insert/reveal-dx-and-reveal-xt-insertable-cardiac-monitors-icms/index.htm).

ILR are placed just under the skin in the left chest and are able to record a patient’s heart rhythm.  It helps to diagnose the cause of syncope (fainting) or any number of heart rhythm disorders.  Initially, doctors try to diagnose heart rhythm disorders with monitors that are worn for 48hours to 2-4weeks; however, an arrhythmia that may only occur every few months will not be detected by a brief snapshot in a patient’s life.  ILR generally last 2-3 years before the battery wears out.

The exciting future of implantable monitors is not simply heart rhythm diagnosis.  Recently, the company MicroCHIPS announced results of the first human clinical trial of an implantable, wireless microchip drug delivery device (http://www.mchips.com/technology.html).  This type of implantable device can allow automated drug delivery over a period of several years.  One can imagine a device that can track a person’s heart rate and dose medication to permit precise control of heart during an abnormal heart rhythm.

Three Dimensional Reconstruction of Left Atrium

The performance of complex cardiac procedures, such as advanced defibrillator placement, structural heart interventions, or arrhythmia ablation, is facilitated by the visualization of 3D anatomy.

     The performance of complex cardiac procedures, such as advanced defibrillator placement, structural heart interventions, or arrhythmia ablation, is facilitated by the visualization of 3D anatomy.  Providing 3D views of internal body structures and interventional devices in one image, this state-of-the-art system assists physicians in diagnosis, surgical planning, interventional procedures and treatment follow-up.     It permits better management of structural heart disease, streamlines interventional procedures, and minimizes radiation dose to physicians, staff and patients by selecting working views without fluoroscopy.  Patients can undergo 3D angiography of the coronary sinus to guide a biventricular defibrillator implantation with a left ventricular pacemaker lead.  Patients can also undergo 3D angiography of the left atrium and pulmonary veins to plan an atrial fibrillation arrhythmia ablation.