Implantable Cardiac Monitors: Evolution Through Disruption

Syncope and stroke are commonly seen in clinical practice, and the diagnostic workup is often time-consuming and costly and may increase resource utilization in the health-care system. The use of implantable cardiac monitors (ICMs) in syncope evaluation has been well studied, but their use in cryptogenic stroke evaluation and anticoagulation management in patients with atrial fibrillation (AF) is still emerging. The standard workup of the syncope patient or those at risk for a possible cardioembolic stroke includes the utilization of external cardiac monitors; however, these devices cannot provide long-term arrhythmia assessment, whereas ICMs can now last up to three years, increasing the possibility of arriving at a diagnosis. Recent studies have shown that ICM use may shorten the time to diagnosis associated with AF, which may affect the prescribed treatment plan, thereby reducing the risks of further stroke. Long term and on a larger scale, this could potentially reduce overall health-care costs, but more studies are needed to confirm whether ICMs can positively decrease such costs and improve patient care. Still, these devices have become smaller and more reliable; additionally, they are now equipped with enhanced diagnostic capabilities, reducing the likelihood of physicians being confronted with an overwhelming amount of data, and supplying them with actionable items to improve patient care. With this growth, ICMs have in effect become a disruptive technology, as their applications in clinical practice continue to grow. Additional studies are warranted to investigate the safety and efficacy of their potential uses.