Telemetric Cardiac Monitoring

“Telemetry was introduced in hospitals during the 1960s to provide continuous cardiac monitoring (CCM) in cardiac intensive care units (ICUs). Over the last five decades, the use of telemetry has expanded beyond the ICU setting to non-critical care settings” (Chen et al., 2018). Over the subsequent years, telemetric cardiac monitoring has progressed to both in hospital and outpatient use.  

The most important types of implanted cardiac telemetry devices are pacemakers and defibrillators. “A pacemaker helps control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. It can speed up a slow heart rhythm, control a fast heart rhythm, and coordinate the chambers of the heart” (Pacemakers, 2021). The shock, 5 volts, is so low that many patients don’t feel it, although some describe it as a tingle. 

Defibrillators, known as Implantable Cardioverter Defibrillators (ICD), provide a much larger electrical shock. They’re designed to reset a heart that has gone into a fatal arrythmia. “ICDs are useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies have shown ICDs to have a role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias” (Aron et al., 2016).

These ICDs are about half the size of a cigarette package and are inserted with minor surgery under the skin.  The cardiologists then run the wires through the chest along veins and insert the leads across the heart. The monitor senses every heartbeat, and when the rhythm changes to something that could be fatal, the ICD delivers a shock of 800 Volts to reset the rhythm. 

Most patients say that the shock feels like a sudden jolt or thump to the chest. Some people black out during fibrillation, so they may not feel anything when the shock is given. If someone is touching the patient when they receive a shock, the toucher may sustain a small muscle jerk, but it will not hurt them (Implantable, n.d.).

The market for cardiac monitoring will continue to increase as our population ages and technology becomes more acceptable. “The global cardiac monitoring and cardiac rhythm management market size was valued at USD 29.0 billion in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 6.5% from 2020 to 2027. Rising incidence of cardiovascular disorders, treatment costs of cardiac diseases, increasing use of ambulatory and home services, favorable government regulation, and technological advancements are the vital drivers for this market for cardiac monitoring and cardiac rhythm management” (Cardiac Monitoring, 2020).

In 2021, anyone can buy a home monitoring system. “If you have certain heart conditions, including atrial fibrillation, it may be important to keep track of your heart rhythm.  You might also want to monitor your heart rate and heart rhythm for other reasons, like when you’re exercising, if you’re pregnant, of if you have other health conditions” (Iftikhar, 2021). The home monitor illustrated here is typical, this one by KardiaMobile available for $89.

This YouTube video discusses preparing for and living with an ICD

(From the University of Kansas Health System.)

References

Aron, J., Weber, M., Soto, L., Merschel, M. (2016, Sept. 30) Implantable Cardiac Defibrillator (ICD). American Heart Association. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/implantable-cardioverter-defibrillator-icd

Cardiac Monitoring And Cardiac Rhythm Management Market Size, Share & Trends Analysis Report By Product, (2020, July). Grand View Reseach. https://www.grandviewresearch.com/industry-analysis/cardiac-monitoring-and-cardiac-rhythm-management-crm-market

Chen, D., Park, R., Young, S., Chalikondra, D., Laothamatas, K., Diemer, G. (2018, Sept. 13). Utilization of Continuous Cardiac Monitoring on Hospital-led Teaching Teams. NCBI Resources. doi: 10.7759/cureus.3300

Iftikhar, N. MD, (2021, April 29). Best EKG Monitors for At-Home Use. Healthline. https://www.healthline.com/health/ecg-monitor

Implantable Cardioverter Defibrillator (ICD) (n.d.) Texas Heart Institute. https://www.texasheart.org/heart-health/heart-information-center/topics/implantable-cardioverter-defibrillator-icd/

Pacemakers and Implantable Defibrillators. (2021, March 30). Medline Plus. https://medlineplus.gov/pacemakersandimplantabledefibrillators.html

Photo Credits

Monitor by GE Dash Electronics

Pacemaker / Defibrillator by Medtronics

Grand View Research

KardiaMobile by AliveCor