An Insertable Cardiac Monitor (ICM) is a small thin device that is inserted under the skin to record the activity of your heart. The ICM monitors and records your heart’s electrical
activity in order to identify any changes to the heart rhythm. You may be experiencing symptoms that indicate you have an abnormal heart rhythm such as palpitations, dizziness, or blackouts and fainting episodes
Hi Sam, I hope this comment is okay and offers a perspective. I had a severe stroke and it was deemed cryptogenic after all the tests. This means there was no obvious cause so an arythmias was suspected. The ICM ( also known as an ILR L=loop) was implanted some time after the event and a further three months went by and a paroxysmal AFib was picked up. This meant an immediate change in medication from the antiplatelet med Clopidogrel to the anticoagulant Edoxaban. Good job I thought and the cardiologist was pleased at his preventative intervention being merited! Move forward 8 months and out of the blue again I have a syncope event and sudden cardiac arrest. Four days in ED and eventual admission to cardiology unit and they eventually interrogated my still in place ILR after me mentioning it countless times. The day after the cardiologist comes in beeming waving an ECG trace saying look you had a left ventricular tachycardia at the precise time of your syncope, lucky you it lasted 23 seconds nearly but not quite fatal. I think I might look like the sort of person that can take gallows humour.
Again an absence of data to explain the event so it was described as idiopathic. Probably caused by a silent heart attack!
There are several ways of reflecting on this episode and the consequences for me.
Firstly the fitting of an ICD (implanted cardioverter defibrillator) was always going to be the treatment whatever might have been the cause of the LVT, together with bisoprolol meds.
Had I not had the ILR fitted and the ECG trace not been found then my diagnosis would have been possible LVT or similar cause. In this case following the ICD implant and hospital discharge I would have been advised to stop driving for a month, similarly to following my stroke.
But, because the trace was found and the ICD implanted I was on a mandatory 6 month ban from driving, which in practice in spite of me originally voluntarily surrendering my licence, means I wasn't able to restart the application process for a new driving licence until the 6 months was up. This involves having had a 6 month clear interrogation of the ICD device data, then having the Cardiologist review the EP technician report and completing a DVLA pro forma to return to me before I can then send it off to the DVLA medical team. So in practice I am still waiting for my licence some 8 months after my event.
During an extended stay in the hospital because of all the getting a test delays, I became concerned at whether my ILR had been regularly monitored before my event because on some occasions my smart watch had shown some very high heart rates corresponding with some minor breathlessness. I logged this and asked the EP team to review my ILR data. I had a very sceptical response to using the smart watch and a rebuttal, nothing to see here. A locum cardiologist in hospital had said in passing that I was clearly having problems before my event, 'last July your heart briefly stopped'. News to me, I had only ever been told about a single short Afib event.
I asked to see ILR monitoring reports but was denied access even after a directive from the PAL's team.
So on one hand the ILR did it's job, medication was changed and I haven't had a further stroke that I'm aware of. But might my LVT have been picked up before my SCA if regular monitoring was taking place? It looks like I'll never know.
The ILR is only as good as the monitoring regime. There has been a large programme to increase implants but I'm not sure this was matched by an increase in monitoring staff.
Very interesting and good job you’re on it and questioning the experts. It just shows that we need to be involved in our own treatment-it’s a 2 way process and it’s unacceptable that you weren’t given access to your records. Thought that it was a given if requested. Sounds as if you’re on the right track now so hope all goes well😊
Last January the hospital was in 'critical incident' and had 'failed' inspection. 4 days on a chair in ED says it all to be followed by six weeks in CCU. At any one point in time, except one, throughout this time the staff were unbelievably dedicated and professional, but they knew they were lurching from extremis to extremis. Yes they should have shared that information, if they had it to share, which I think is more to the point. It is the point at which I guess the staff tread that line between getting the job done, and not answering a question beyond their grade. IE not their position to say nobody was monitoring your device or push the hard pressed staff to trawl through history. I needed the best care available, have worked in front line services, and wasn't going to push it.But all the recent enquiries have highlighted the need for a duty of candour, which is sort of gobsmacking that it doesn't automatically exist within the medical system (UK).
I guess I added this not to be negative but to inject some realism. Had I thought that what happens to all the data going from my bedside bed may not have been monitored I would have checked more to make sure it was.
And to emphasise the point I'll conclude the tail to show the suspicion has more substance. My ICD was fitted and I was discharged late the same day. By the time I got home I was experiencing a whole new experience of bumps and awareness I had a heart!!! By night time, when I lay on my back I was getting full on thumps that made me bounce!!!
I contacted the hospital, left messages and eventually spoke to someone 4 days later. By now I was experiencing constant breathlessness during the day. The EP technician checked my data, reluctantly, and said that phrase 'nothing to see here', 'you'll get used to it's. After another three days of what began to feel life wasn't worth living I took myself to A&E. X-rays were taken and the same locum consultant was on and said possibly a detached lead but also your not coping with the pacing function of the device but discharged me. Two weeks later, all this time was purgatory, an urgent early morning call from the EP, 'pack an overnight bag, come in now, be prepared for an operation '!. In the end the pacing lead function was switched off, that lead was detached, but the main defib lead was working and protecting me and I was discharged with an advisory I would be called back, as no possibility of doing the revision today!
I was then called back after a further three weeks of not being great to have a lead revision procedure.
In the medical notes , no reference was made to my day one failed operation, the detachment was noticed ' immediately ' at three weeks by the EP and acted upon swiftly, and I elected to have a revision procedure. Duty of candour!?
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