PVC Detection - ICM Feature
PVC Detection is a Medtronic LINQ II™ Insertable Cardiac Monitor (ICM) feature that detects and tracks the daily burden of premature ventricular contractions. This feature is appropriate for patients experiencing symptoms such as palpitations where the percent of beats that are PVCs (PVC burden) may lead to changes in treatment.
This feature can be found in some Medtronic insertable cardiac monitor (ICM) devices. Please go to manuals.medtronic.com or consult with your local Medtronic representative regarding device models available in your geography.
All patient and clinical data on the screenshots in this document are fictitious and for demonstration purposes only.
LINQ II™
PVCs Detection can be set (On, OFF)
Nominals setting in bold.
Remote Programming Using the Medtronic CareLink™ network
To program PVC Detection in LINQ II, go to Patient Details >Device Settings-> PVCs Detection, which is nominally OFF.
Programming with the REVEAL LINQ™ Mobile Manager (LMM) APP
To program PVC Detection in LINQ II, go to Device & Patient Settings-> PVCs Detection, which is nominally OFF
The automatic detection PVCs is turned on when you enable the feature. The feature is defaulted Off at time of insertion but can be enabled in-person or remotely.
The PVC Detection feature uses a 3-beat analysis to determine presence of a PVC. Both morphology and R-R timing are used in the algorithm.
The timing component is looking for a LONG-SHORT-LONG pattern starting prior to the first of the 3 beats.
In the image below, the morphology component compares morphologies between the beats themselves. Beat pairing (1,3) need to be similar within a defined range to one another. Beat pairings (1,2) and (2,3) must be different. To determine if the beats are similar or different the sum of the point by point difference of the signals is used.
The PVC detector is highly sensitive to various types of PVCs with the exception of couplets and triplets as they fail the 3 beat morphology criteria listed above.
| Type of PVC | Included in PVC Detection |
|---|---|
| Unifocal – PVCs originating from the same focus in the ventricle, resulting in a uniform shape. | Yes |
| Multifocal – PVCs originating from different origins resulting in different shapes. | Yes |
| Bigeminy – PVC every other beat | Yes |
| Trigeminy – PVC every third beat | Yes |
| Quadrigeminy – PVC every fourth beat | Yes |
| Couplet or Triplet PVCs | No. PVC detection evaluates beats for changes in morphology. Couplets/Triplets do not meet this criterion. |
Overall, PVC detection was designed for high specificity, (the ability to rule out unwanted signals such as PACs or sinus rhythm) with high sensitivity (the ability to correctly identify ALLPVCs as a secondary goal. A focus on specificity allows for the reported value to be a minimum estimate where overestimating the PVC burden could lead to premature therapy when a specific burden threshold target is being used.
Programming considerations:
- PVC detection can be programmed On or Off. PVC detection should be enabled for patients where PVC burden data would be useful for their follow-up care.
Viewing Episodes
PVC detection does not generate a stored episode.
The PVC burden can be viewed remotely on the CareLink™ network by navigating to the Trends tab under Transmission Details and viewing the Cardiac Compass™ Trends. Also, the Quick Look tab will display both the lifetime PVC burden as well as the new PVC burden since the last view of the patient. For in-person follow-up, PVC burden can be viewed using LINQ Mobile Manager (LMM) by opening Trends window and viewing Cardiac Compass or via the Quick Look window and viewing the counters section.
The example below illustrates a Report that was generated by CareLink. The Cardiac Compass™ Trends plot depicts the daily PVC burden values (% of Beats that were PVC) over the past 90 days.
References
Source: Medtronic Reveal LINQ™ LNQ11 Clinician Manual. Medtronic LINQ II™ LNQ22 Clinician Manual. Medtronic data on file 2020.
Last updated:
09 Nov 2020