Key result
Implantable cardiac monitors yielded 4-year cumulative indication-related diagnosis rates of 39% for syncope and 28% for cryptogenic stroke with low late complication rates.
Why the study?
What is the long-term diagnostic efficacy, post-diagnosis management, and safety of implantable cardiac monitors up to 5 years after implantation in real-world clinical practice?
Cohort (n=1,249)
Yes
What is the long-term diagnostic efficacy, post-diagnosis management, and safety of implantable cardiac monitors up to 5 years after implantation in real-world clinical practice?
Implantable cardiac monitors continue to yield clinically meaningful arrhythmia diagnoses into the third and fourth years after implantation with low long-term complication and explantation risks.
Answers are grounded in this paper and cite their sources.
May support extended ICM monitoring; leaves open randomized trials to confirm outcome impact.
BACKGROUND: Implantable cardiac monitors (ICMs) provide long-term monitoring for cardiac arrhythmias. This analysis summarizes late diagnoses, patient management and complications until 5 years after implantation. METHODS: The BIO|STREAM-ICM study is an ongoing, prospective registry capturing the real-world application of ICMs at 38 sites across 9 countries. Patients with any ICM indication are followed until device information is no longer clinically utilized. All arrhythmia diagnoses were assessed for relevance to the device indication. RESULTS: Of 1249 patients included in the present analysis, most received an ICM after syncope (56%) or cryptogenic stroke (30%). Follow-up extended to 5 years, 34% of patients had at least 3 years of monitoring. Kaplan-Meier estimates of the cumulative incidence of indication-related diagnosis were 31%, 36%, and 39% for syncope, and 21%, 24%, and 28% for cryptogenic stroke at 2, 3, and 4 years, respectively. After diagnosis, ICMs were explanted in 46% of cases, continued for monitoring of therapy efficacy in 41%, and inactivated but left in situ in 12%. Explantations needed a median duration of 10 min and were characterized as easy or very easy in 86% of cases. Six device related adverse events occurred later than 180 days after insertion, and none in the context of explantations. CONCLUSION: ICMs continue to deliver clinically meaningful arrhythmia diagnoses in the third and fourth year post-implantation, even when the preceding follow-up has been uneventful. Long-term follow-up and explantation have a low risk. Our results affirm the safety and efficacy over the device's lifetime in clinical practice.
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Martens et al. (2026) conducted a cohort in Cardiac arrhythmias (primarily syncope or cryptogenic stroke) (n=1,249). Implantable cardiac monitor (ICM) was evaluated on Cumulative incidence of indication-related arrhythmia diagnosis at 4 years (syncope subgroup). Implantable cardiac monitors yielded 4-year cumulative indication-related diagnosis rates of 39% for syncope and 28% for cryptogenic stroke with low late complication rates.
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