Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical Note
Objectives: Insertable cardiac monitors (ICM) allow continuous long-term electrocardiogram monitoring and the detection of paroxysmal atrial fibrillation (PAF) in patients with cryptogenic stroke (CS). Several years have passed since ICM was indicated for CS, and many stroke neurologists will experi...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2308-3425/10/1/15 |
| _version_ | 1797440801387577344 |
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| author | Shuhei Egashira Naoto Kimura Ryosuke Doijiri |
| author_facet | Shuhei Egashira Naoto Kimura Ryosuke Doijiri |
| author_sort | Shuhei Egashira |
| collection | DOAJ |
| description | Objectives: Insertable cardiac monitors (ICM) allow continuous long-term electrocardiogram monitoring and the detection of paroxysmal atrial fibrillation (PAF) in patients with cryptogenic stroke (CS). Several years have passed since ICM was indicated for CS, and many stroke neurologists will experience cases in which ICM removal is required. As a standard protocol, reincision of the wound at the time of implantation has been proposed by ICM brands. However, it may be difficult due to adhesions of subcutaneous tissue, migration of the device from its original position, and the capsule formed around the device. Our objective is to describe simple alternative techniques for successful ICM removal. Materials and Methods: From December 2016 to September 2021, 37 patients with CS underwent ICM removal at our institution. The device was removed through an incision directly above the proximal end of the device, perpendicular to the wound at the time of ICM implantation. The subcutaneous tissue was removed bluntly using forceps along the edges of the proximal end of the device. When a capsule was attached to the device, we cut the capsule with the blade to release the device. Once the device was visible, the proximal end of the device was grasped with forceps, and the device was pulled from the pocket with gentle traction. All patients undergoing ICM removal received a systematic check for wound dehiscence, wound infection, bleeding, and tissue ischemia at an outpatient examination of 1 week. The 37 patients who underwent removal of ICM were retrospectively reviewed in the medical record and analyzed for procedural success, intraoperative complications, and wound course at one week. Results: All patients achieved procedural success. There were no intraoperative complications, wound dehiscence, bleeding, or skin ischemia at one week postoperatively. The reasons for removal were battery depletion in 65%, early removal before battery life after PAF detection in 32%, and exposure to the body surface in 3%. The devices removed were 62% Reveal LINQ (Medtronic, Minneapolis), 30% Confirm Rx (Abbott, Illinois), and 8% BioMonitor 2 (BIOTRONIK, Berlin), indicating that our method is effective regardless of model. Conclusion: We describe a simple technique for ICM removal for CS that is safe, reliable, and potentially effective in wound healing. |
| first_indexed | 2024-03-09T12:13:41Z |
| format | Article |
| id | doaj.art-40c475ad37bb41b0a70c51cab6229ed9 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T12:13:41Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-40c475ad37bb41b0a70c51cab6229ed92023-11-30T22:49:09ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-01-011011510.3390/jcdd10010015Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical NoteShuhei Egashira0Naoto Kimura1Ryosuke Doijiri2Stroke Center, Iwate Prefectural Central Hospital, Morioka 020-0066, JapanStroke Center, Iwate Prefectural Central Hospital, Morioka 020-0066, JapanStroke Center, Iwate Prefectural Central Hospital, Morioka 020-0066, JapanObjectives: Insertable cardiac monitors (ICM) allow continuous long-term electrocardiogram monitoring and the detection of paroxysmal atrial fibrillation (PAF) in patients with cryptogenic stroke (CS). Several years have passed since ICM was indicated for CS, and many stroke neurologists will experience cases in which ICM removal is required. As a standard protocol, reincision of the wound at the time of implantation has been proposed by ICM brands. However, it may be difficult due to adhesions of subcutaneous tissue, migration of the device from its original position, and the capsule formed around the device. Our objective is to describe simple alternative techniques for successful ICM removal. Materials and Methods: From December 2016 to September 2021, 37 patients with CS underwent ICM removal at our institution. The device was removed through an incision directly above the proximal end of the device, perpendicular to the wound at the time of ICM implantation. The subcutaneous tissue was removed bluntly using forceps along the edges of the proximal end of the device. When a capsule was attached to the device, we cut the capsule with the blade to release the device. Once the device was visible, the proximal end of the device was grasped with forceps, and the device was pulled from the pocket with gentle traction. All patients undergoing ICM removal received a systematic check for wound dehiscence, wound infection, bleeding, and tissue ischemia at an outpatient examination of 1 week. The 37 patients who underwent removal of ICM were retrospectively reviewed in the medical record and analyzed for procedural success, intraoperative complications, and wound course at one week. Results: All patients achieved procedural success. There were no intraoperative complications, wound dehiscence, bleeding, or skin ischemia at one week postoperatively. The reasons for removal were battery depletion in 65%, early removal before battery life after PAF detection in 32%, and exposure to the body surface in 3%. The devices removed were 62% Reveal LINQ (Medtronic, Minneapolis), 30% Confirm Rx (Abbott, Illinois), and 8% BioMonitor 2 (BIOTRONIK, Berlin), indicating that our method is effective regardless of model. Conclusion: We describe a simple technique for ICM removal for CS that is safe, reliable, and potentially effective in wound healing.https://www.mdpi.com/2308-3425/10/1/15insertable cardiac monitorcryptogenic strokeremoval |
| spellingShingle | Shuhei Egashira Naoto Kimura Ryosuke Doijiri Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical Note Journal of Cardiovascular Development and Disease insertable cardiac monitor cryptogenic stroke removal |
| title | Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical Note |
| title_full | Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical Note |
| title_fullStr | Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical Note |
| title_full_unstemmed | Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical Note |
| title_short | Removal of Insertable Cardiac Monitor for Cryptogenic Stroke: A Technical Note |
| title_sort | removal of insertable cardiac monitor for cryptogenic stroke a technical note |
| topic | insertable cardiac monitor cryptogenic stroke removal |
| url | https://www.mdpi.com/2308-3425/10/1/15 |
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