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Arrhythmia Monitoring May Remain Beneficial Despite Missing Primary Endpoints

Peter Sogaard discusses the benefit of monitoring for arrhythmias in patients with non-STEMI heart attacks and the need to look at arrhythmias in a different light.

New data suggest patients who received an implantable heart rhythm monitor following myocardial infarction did not have subsequent fewer overall cardiovascular events.

However, despite not meeting this primary study endpoint, patients with non-ST segment elevation myocardial infarction (NSTEMI) saw strong benefits which may help guide future care.

Peter Sogaard, Professor of Cardiology, Aalborg University presented the findings at The American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC.

In an interview with HCPLive, Sogaard described how arrhythmias were not just recorded in the study, but action was taken by investigators.

He noted that medication was often changed. For some patients, anticoagulation was added due to detection of long lasting atrial fibrillation, while others had medical therapy uptitrated or downregulated. Pacemaker implants were additionally performed, as well as percutaneous coronary intervention (PCI).

"The arrhythmia is actually the sign of some kind of progression in the underlying disease or a side effect of the the initial prescribed treatment," Sogaard said. "I think we have to look at arrhythmias in a different way."

He noted his interest in remote monitoring of arrhythmias, noting that in the past, loop recorders could not reliably transmit data. However, it kept record of when a patient had an arrhythmia and how long it took until they suffered a cardiovascular event.

Generally, patients had a major cardiovascular outcome within a few months following an arrhythmic event, indicating increasing risk. However, patients often did not recognize the arrhythmia and thus, cannot respond to it.

"I think that for remote monitoring in the future, it's very important that we consider carefully what we record and put together the optimum recording sequences and collection of data sequences that will improve the patient's outcome," he said. "I'm pretty sure that it will reduce hospital costs, and that it will improve outcomes."

Moreover, Sogaard theorized the AI approach of identifying patterns in the loop recordings and daily transmission information could benefit screening.

"One of the approaches that we will see in the future could be the AI approach to subtle changes in the reported or daily reported arithmetic strips or rhythm strips, where we could potentially identify an earlier point in time and identify the risk of a later arrhythmia," he said.

"The Clinical Effect Of Arrhythmia Monitoring After Myocardial Infarction," was presented at ACC 2022.