Ben Ng

BioMonitor 2 Pilot Study: Early Experience With Implantation of the Biotronik BioMonitor 2 Implantable Cardiac Monitor

BACKGROUND The BioMonitor 2 Pilot Study assessed the implantation procedure, the sensing amplitude and the remote monitoring transmission success rate of the second generation implantable cardiac monitor, the BioMonitor 2 (Biotronik, Berlin, Germany). METHODS This was a prospective, multi-centre, single-arm, non-randomised study involving seven operators in five sites across Australia. Data were collected at implantation, during clinic visits at 1 week and 1 month post-implantation, and through wireless remote monitoring. RESULTS Thirty patients with indications for long-term cardiac monitoring underwent successful insertion of a study device. The median implantation time was 9 minutes (interquartile range (IQR) 5-14 mins). The mean R-wave amplitude at 1 week was 0.75±0.39mV and remained stable over the follow-up period. Within 1 day, 97% of the patients connected to the remote monitoring network and daily messages were transmitted on 93.8% of all study days. Seventy-six per cent of patients transmitted at least one subcutaneous ECG (sECG), with a median number of sECGs per patient of seven (IQR 3-37) within 28 days. CONCLUSIONS The results of the BioMonitor 2 Pilot study confirm the excellent sensing amplitudes afforded by this new device and the utility of the implantation tools and technique. Patient compliance with and the transmission success rate of the home monitoring system were excellent.

Broad complex tachycardia in a patient with a pacemaker: What is the mechanism?

Introduction Permanent pacemakers have the capacity to sense, detect, and store tachyarrhythmia episodes, providing clinicians with a valuable diagnostic tool that can be utilized for decision making and patient management. Algorithms predominantly use rate and regularity for detection, with electrograms (EGMs) helping in discrimination between ventricular (VT) and supraventricular tachycardias (SVT). The case we present seeks to highlight a potentially common pitfall that should be recognized, owing to its clinical implications.

Atrial Fibrillation Resulting from Superior Vena Cava Drivers Addressed with Cryoballoon Ablation: Late Reconnection at the Site of Phrenic Nerve Pacing Catheter

Introduction Cryoballoon ablation is now an established approach for achieving pulmonary vein (PV) isolation, as part of the management of drug-refractory symptomatic atrial fibrillation (AF). More recently, the technique has been utilized for successful isolation of the superior vena cava (SVC). We present a case highlighting a potential pitfall affecting the durability of SVC isolation using the cryoballoon.