Case 1: Hidden Cause and Patient Compliance
Case 2: Screenings/Surveillance and Ongoing Care Management
Case 3: Insightful Data Based on Arrhythmia Type
Abbott's Jot Dx™ Insertable Cardiac Monitor (ICM) with SharpSense™ Technology offers healthcare professionals a choice – viewing 3 key episodes or all episodes – and, if you change your mind, you can easily toggle between the two.
Whether choosing the key episodes feature to reduce data burden without sacrificing accuracy, or the all data mode to catch those hard-to-detect arrhythmias, the Jot Dx ICM gives you the precise, actionable EGM insights you need to provide an accurate diagnosis.
On this page, our expert, Dr. Rajdeep Gaitonde, shares his experience with Jot Dx ICM, and how he has applied each of these modes, or both, in his own clinical cases.
A female patient was implanted with the Jot Dx ICM for a history of bradycardia. ICM 3 Key Episodes was turned on because she had a longstanding history of bradycardia. The 3 Key Episodes indicated that the bradycardia episodes were primarily nocturnal, suggestive of sleep apnea. The Clinician ordered a sleep study, and she was diagnosed with sleep apnea and fitted with a CPAP machine. Subsequent monthly transmissions received from the ICM showed no further episodes of bradycardia. In this case, implantation of the Jot Dx ICM helped to identify sleep apnea and that this was the etiology for her bradycardia. This also demonstrates how the ICM can remain in service at a low data burden to remotely assess long-term compliance of wearing a CPAP (i.e., recurrent nocturnal bradycardia is equivalent to noncompliance with the CPAP machine).
The Jot Dx ICM served essentially as a compliance "watchdog" and lent insight into treatment efficacy. Arrhythmia episodes recurrent to compliant CPAP patients wearing masks should create clinical suspicion of changes to the therapy and/or other etiologies, versus waning efficacy. Arrhythmia episodes recurrent to compliant CPAP patients wearing masks should create clinical suspicion of changes to the therapy and/or other etiologies, versus waning efficacy of the treatment. The situation may be more concerning if neither of the above proves out, especially if the patient's episodes are longer. These insights and other information from the ICM provide the HCP with a guide to which way to direct the patient or if further investigation is needed.
A female patient had presented with a history of cryptogenic stroke as well as palpatations. Previous ambulatory monitoring revealed what appeared to be a possible slow atrial flutter. She also had a history of sleep apnea – somewhat noncompliant with her sleep mask. At implant, 3 Key Episodes was off so that we could see All Episodes. Expecting to reveal a slow atrial flutter, we ended up finding atrial fibrillation. She was also noted to have nocturnal bradycardia. She underwent atrial fibrillation ablation, and 3 Key Episodes was turned back ON to manage her atrial fibrillation as well as CPAP compliance.
This case served as an example of how we toggled between modes based on the indication and management of the patient. At first, we were screening for arrhythmias that could be responsible for cryptogenic stroke. Later after paroxysmal atrial fibrillation was identified, she underwent ablation, and we could follow her long-term management with toggling back to 3 Key Episodes. We could also follow her compliance with the CPAP with bradycardiac key episodes.
A female patient was having intermittent episodes of frank syncope with no clear cut etiology, as well as a history of stroke-like symptoms. A neurologic workup was negative. Previous ambulatory monitoring was unremarkable. We proceeded with an EP study that showed no obvious conduction system abnormalities. She then underwent implantation of a Jot Dx ICM for long-term ambulatory monitoring to evaluate for possible sinus node dysfunction versus a possible arrhythmic etiology for the questionable stroke events. We programmed 3 Key Episodes to ON, as we had a strong suspicion of sinus node dysfunction and there was no obvious evidence of thrombotic stroke. EGM data from the ICM found three > 10-second pauses, which correlated with her syncopal episodes as she was having Stokes-Adams attacks. She, therefore, met Class I indications for a pacemaker and underwent implantation of a dual-chamber pacemaker with advanced hysteresis programmed ON. After implantation, her neurologic symptoms resolved. Key episodes and evaluation criteria for pause episodes from the Jot Dx ICM including longest, second longest, and shortest episodes provided clinically-relevant data for appropriate treatment.