1/ Welcome to Journal Club! This program is accredited for 0.5h CE credit. Complete it and then follow directions (in next Thursday’s final tweet in this series) for claiming credit. So easy! This program supported by grants from Abbott and Bayer. Ready to go???
2/ Prolonged rhythm monitoring with a SQ insertable cardiac monitor (ICM) is of diagnostic value in patients with unexplained recurrent syncope. DDx includes unproven epilepsy, unexplained falls, and other arrhythmias.
3/ 2018 ESC Guidelines suggest ICM instead of an ICD in many patients with recurrent unexplained syncope and low risk of SCD. ICM may be esp useful in different those with neurally mediated syncope, BBB, or structural heart disease--more so than tilt table or Holter.
4/ Currently available ICMs:
5/ In CARISMA, 297 patients with LVEF≤40% 3-21d post-AMI were followed with an ICM for (mean) 1.9y. Arrhythmias documented: new-onset AF (28%), non-sustained VT (13%), high-degree AV block (10%). Which of these was strongest predictor of cardiac death?
Answer the poll before Tuesday, when we'll continue this Journal Club. You'll be able to claim your credit on Thursday.
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6/ High-degree AV block was the most powerful predictor of cardiac death. Guidelines currently don’t recommend routine ICM post-MI, unless patients have recurrent unexplained syncope with systolic impairment and don’t have a current indication for an ICD.
7/ REVISE study: 103 pts with epilepsy but likely misdiagnosed. Enrolled if 3/+transient LOC episodes in yr before enrol. ICM recorded profound bradyarrhythmia or asystole with convulsive features in 21%, who were offered pacemaker. After pacing and d/c sz meds, 60% became asx.
8/ ESUS cryptogenic stroke: a good indication for ICM, as recurrence is common and AF detection might allow treatment. Intermittent monitoring (annual 24h or quarterly 7d Holter) for AF inferior to cont ICM. ICMs shown to be a cost-effective dx'ic tool for sec prevention in ESUS.