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Atrial Fibrillation and Stroke, Insertable Cardiac Monitoring and Medicaton

Merritt 620

Most people have plenty of plans and expectations for after they retire. 68 year-old Daniel Merritt's retirement looks a lot like what most people dream about. He is active. He has projects and hobbies. He has a beautiful historic home on a lovely property in the Hockessin, Delaware area. He plays golf four or five times a week. He and his wife, Barbara, have three grown daughters and six grandchildren, and the family gets together often back in Chester County where the couple once lived.

It appears as if life couldn't be better for Daniel Merritt. But, as we all know, things are not always exactly how they appear. Daniel's retirement is not as picture perfect as it may seem. In 2008, he began experiencing a wide range of worrisome symptoms and health-related occurrences that would continue to come and go without warning for years.

"I never had high blood pressure or high cholesterol. I was healthy. But, all of a sudden, I was having chest pains, shoulder pains, sometimes nausea, eye floaters, flushing and other things. I never knew what to expect or when to expect it," Daniel recalls. "I had 67 incidences during the first six months of 2008. Many happened while I was at rest or even sleeping. Some nights I'd wake up out of a sound sleep with pain in my neck and chest area. I would get up and pace until the pain went away."

Daniel went through many medical tests, but nothing was conclusive. He wore a Holter monitor for a month and a half to help doctors determine what was going on. His heart rhythms were recorded by the portable device, which is about the size of a deck of cards, for 24 hours a day. The monitor is somewhat inconvenient and must be attached to the body at all times with adhesive patches.

In many cases, a Holter monitor is able to help doctors make lifesaving discoveries. However, the challenge when monitoring for heart arrhythmias is they are usually sporadic and unpredictable. In order to diagnose problems, the heart must be monitored as an event occurs. Daniel did not have any episodes while wearing the Holter monitor.

Daniel's mysterious health problems continued. On Halloween in 2013, he had two separate incidences of slurring his words and losing his ability to speak. "I went to Chester County Hospital, and they checked me in for five days. This is where I met my Cardiologist Raghuram Mallya, MD," he says. "My speech returned, but I was diagnosed as having had two strokes. On the MRI, I could actually see the affected spots on my brain. They sort of glowed."

He was prescribed medication and went on with his normal everyday activities. Unfortunately, Daniel's symptoms also continued as usual, intermittently disrupting his life. Only four months after his initial stroke, Daniel experienced another. This time he lost his eyesight. Again, the loss was temporary. He was admitted to the hospital again.

/-/media/images/chestercounty/migrated/150204linq02.ashxWhen traditional testing methods did not prove helpful, Dr. Mallya recommended trying newer technology, specifically the Medtronic Reveal LINQ, which is an Insertable Cardiac Monitoring (ICM) loop system. Dr. Mallya felt the new device might detect something going on with Daniel's heart that could have caused the strokes and perhaps some of his other symptoms. Daniel agreed and, in July of 2014, he became the first person to have an ICM implanted at Chester County Hospital. Interventional Cardiologist Richard Hui, MD, implanted the small hardware.

A Medtronic Reveal LINQ loop monitor is a tiny device, approximately one-third the size of an AAA battery, which is inserted underneath the skin over the left chest. The device is put in place via a minimally invasive procedure, using local anesthesia.

"The procedure was over quickly, and I was awake for the whole thing," says Daniel. "They made a tiny incision and then implanted the monitor through this small plastic tube that was even smaller than one of those old fashioned pen ink refills. They removed the tube once the monitor was in. That was it. Afterwards, I had a small bump on my chest I could feel with my fingers, but nothing obvious."

Once his ICM was in place, it began collecting heart rhythm data continuously. Each night, while Daniel slept, information was downloaded from the monitor in his chest to a small device he kept at his bedside using Bluetooth technology. The data was then wirelessly and securely transmitted via the Internet for analysis by his cardiology team.

Daniel also was provided with a small handheld device to use if he experienced anything he thought his cardiologist should know about right away. If needed, he could hold the device over the monitor in his chest while he was having - or felt he was about to have - an episode, and the data would be exported immediately.

He did not feel chest pain or other severe symptoms between July and November while the device was in place, although he did continue to experience minor discomforts here and there. So when he found out the ICM had indeed recorded two episodes of Atrial Fibrillation (AF or AFib), a heart-rhythm disorder, he was extremely surprised. AFib is a very fast and irregular heartbeat that can affect blood flow within the body. It can cause a variety of symptoms and lead to blood clots, stroke or heart failure. Fortunately, when AFib is detected, medical steps can be taken to address the problem.

Daniel now takes a variety of medications that have helped reduce many of his symptoms, although he still experiences a few. Whether the medications he is currently taking will fully address all his health issues or not is something that will take more time and medical attention to answer. Adjustments and further investigation may be needed.

"If the AFib had not been discovered, would I have had more strokes? Probably. Would I be dragging an arm or leg or in a wheelchair? It's possible. Would I have died? It's possible," says Daniel. "So did that little device make a real difference in my life? Yes, it did. I feel like we are finally getting somewhere."

Daniel Merritt listened to his body and sought out answers. He suggests, "Listen to and feel what your body is telling you. Be persistent. Seek out information and follow through with a team of physicians you trust. New technology, like the loop monitoring device, is creating options that could be relevant to your health situation. It definitely impacted mine."

Written By Beth Eburn
Photo by Rick Davis


Hear Daniel's story in his own words.

Learn more about the LINQ Loop recorder and its role in the diagnosis
of atrial fibrillation. Electrophysiologist Dr. Richard Hui breaks down
the science behind the electrical impulses of the heart and how new
technologies are helping to treat patients better than ever before.

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