![]() ![]() These subjects were identified by querying available encounters in the database for an International Classification of Diseases ( ICD), Ninth Revision ( ICD‐9) or Tenth Revision ( ICD‐10) code or Current Procedural Terminology code consistent with ICM insertion (Table S1). Furthermore, we sought to describe the characteristics of pediatric patients undergoing ICM implantation, as well as report device complications and subsequent therapeutic interventions.Įligible subjects were children and adolescents (0–18 years) who underwent ICM insertion and with data in the MarketScan commercial and/or Medicaid databases between January 1, 2013, and December 31, 2018. We hypothesized that the rate of ICM implantation would increase following LINQ release in February of 2014. ![]() To provide an estimate of use in the United States, we analyzed data from an insurance claims database that included recipients of both commercial and public coverage for the years 2013 to 2018. The impact of miniaturization on real‐world use of ICMs in pediatric patients has, to our knowledge, not been evaluated. With a volume of 1.18 mL, this device was 87% smaller than its predecessor, the Reveal XT at 9 mL, 3 promising shorter procedure and recovery times, as well as expansion of eligible recipients to smaller and younger patients. In February 2014, the Reveal LINQ (Medtronic INC., Minneapolis, MN) received US Food and Drug Administration approval. 1, 2 Significant progress has been made to make ICMs smaller to allow the procedure to be less invasive and less morbid. Efficacy of this method in the pediatric population has been established in prior studies. The Insertable cardiac monitor (ICM) is a valuable tool in the evaluation of syncope and palpitations when ambulatory noninvasive rhythm monitoring has not provided a definitive diagnosis. The effects of increased use on outcomes and value deserve further attention. While use has increased, overall number of implants and complications remains relatively low. Of 394 subjects with ≥1 year of follow‐up after implantation, interventions included catheter ablation in 24 (6%), pacemaker implantation in 15 (4%), and implantable cardioverter‐defibrillator implantation in 7 (2%). Following release of the miniaturized ICM, use of ICMs increased from 5 procedures per million enrollees in 2013 to 11 per million between 20 ( P<0.001), while balancing measures remained static. A history of syncope was present in 71%, palpitations in 43%, and congenital heart disease in 28%. Subjects who underwent ICM implantation were 52% male sex, with a median age of 16 years (interquartile range, 10–17 years). The study cohort included 33 532 185 individual subjects, of which 769 (0.002%) underwent ICM implantation. Secondary analyses included evaluations of subsequent interventions and complications. Use of ICM between January 2013 and December 2018 was measured (normalized to the total enrolled population ≤18 years) and compared with balancing measures (Holter ambulatory monitors, cardiac event monitors, encounters with syncope diagnosis, implantation of implantable cardioverter‐defibrillator/pacemaker). Stroke: Vascular and Interventional NeurologyĪ retrospective observational study was conducted using administrative claims from MarketScan Medicaid and commercial insurance claims databases.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB). ![]() They are often used in patients with cryptogenic stroke and transient ischemic attack to determine if the patient has atrial fibrillation or other heart rhythm issues. ICMs are used for longer term cardiac monitoring to help diagnose patients with symptoms of transient arrhythmias. The system also allows remote programming of the cardiac monitor so the patient does not need to come into the office. This automatically allows event notification triggers and actionable alerts. The Linq II device also offers Bluetooth connectivity with the patient's smartphone to increase real-time monitoring away from the base station. The Reveal Linq device provides about 3 years of battery life. The Linq II insertable cardiac monitoring system offers an extended battery life for 4.5 years of monitoring. ![]()
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