On Dec. 7, 2017 at Elmhurst Hospital, 42-year-old Nolan Southfield became the first patient in the Chicago area to receive a Confirm Rx Insertable Cardiac Monitor (ICM). This device is the first heart monitor that enables patients to use their own smart phones to transmit their heart rhythm information to their doctor’s office. Unlike other monitoring systems, there is no need for a separate patient activator and bedside transmitter.

Cash Casey, M.D., an independent cardiac electrophysiologist and a member of Elmhurst Hospital’s medical staff, inserted the small device just under Southfield’s skin in an outpatient procedure using a local anesthetic.

"The procedure itself was over in about 10 minutes and all I felt was some pressure," says Southfield. "It was quick and simple."

Dr. Casey recommended Southfield undergo heart monitoring in part because he fainted at work and was taken to the emergency room (ER) with a pulse rate that had dipped below 20.

Southfield says, "I fainted a few more times in the ER and they gave me a temporary pacemaker."

A series of cardiac tests were all negative. The doctors concluded his problems may have been caused by dehydration, stress and recent weight loss. Southfield was advised to follow up with a cardiologist, so he made an appointment with Dr. Casey.

Cardiac monitoring is a key diagnostic tool when a person’s heart is beating too fast, too slow or at an irregular rhythm (arrhythmia). Depending on the nature of the problem, symptoms might include dizziness, fatigue, palpitations or fainting.

Common types of heart monitoring include:

• The basic heart monitor is an electrocardiogram (EKG), which measures how the heart works at one point in time. Sometimes, a longer term assessment is needed, especially if there are no, or only intermittent, symptoms.
  
  
• A 24- to 48-hour Holter monitor might be sufficient if symptoms occur at least once a day. For this test, a small EKG monitor continuously records the heart’s rhythm, using wires attached to your skin with patches. The device is carried on the waistband or in a pocket.
  
  
• When symptoms appear less frequent than daily, a similar device, called an event recorder, may be recommended. This device, which is typically used for 30 days, only records when a symptom is detected or if activated by the patient when he/she experiences a symptom.

For less frequent symptoms, or if your doctor wants more information on your condition, an insertable cardiac monitor (ICM), such as the Confirm Rx ICM, can keep tabs on your heart rhythm for a period of two years or longer.

A common use of an ICM is detecting or ruling out arrhythmia, a problem that can be difficult to diagnose because it may come with infrequent symptoms or none at all. Atrial fibrillation, one type of irregular heart rhythm, is the most common cause of stroke due to arrhythmia.

Compared to standard testing, an ICM is six to seven times more likely to detect atrial fibrillation, according to a science report presented at the 2014 American Stroke Association International Conference. The ICM’s ability to detect atrial fibrillation can be especially valuable for the 20-40 percent of ischemic stroke patients whose stroke was determined to be "of unknown cause."

Dr. Casey says the ICM’s longer monitoring period is key because "studies have shown it takes an average of 84 days to diagnose atrial fibrillation in these patients." When atrial fibrillation is identified as the cause, blood thinning medications can be prescribed to reduce the risk of another stroke.

"You can always remove the device once a diagnosis is made and treatment is started," says Dr. Casey. "We sometimes leave it in for a while to see how well the treatment is working."

"Since I’ve been on the monitor the device has picked up two episodes of atrial fibrillation and one heart pause," says Southfield. "I entered a fourth symptom myself when I was feeling a bit light-headed. The office has always called me back within 24 hours to discuss what I experienced.

"I don’t even feel the device is there unless I rub my chest. I think the biggest advantage is that I don’t have to think about it, beyond remembering to put my phone on the charger at night and leave the app open."

Says Dr. Casey, "ICMs have been around for five or six years, but the Confirm Rx is the most programmable, allowing you to make changes that improve accuracy. And it’s more comfortable for the patient because they can use their own phone to transmit anywhere and easily connect with the office. With the Confirm device, the patient can be more in control of their own care."

Learn more about innovations in cardiac care at Edward-Elmhurst Health.

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