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High False Positives Found For Medtronics Implantable Af Detectors

High False Positives Found For Medtronics Implantable Af Detectors

High false positives found for Medtronics implantable AF detectors LOS ANGELES Medtronics Reveal LINQ implantable loop recorders misidentified 84% of rhythm anomalies as atrial fibrillation in 52 stroke patients at Emory University in Atlanta, according to a presentation at the International Stroke Conference. Two electrophysiologists reviewed a random sample of 166 rhythm strips from those patients that were identified by Reveal as atrial fibrillation (AF) over a 2-month period; 140 (84%) were false positives. Eighty (57%) of the false positives were premature atrial complexes, 31 (22%) were due to T wave over-sensing, 14 (10%) to noise, 7 (5%) to premature ventricular complexes, 4 (2.9%) to under-sensing, and 4 (2.9%) to sinus arrhythmias. There wasnt a mix-and-match of true and false positives in the same patient; false and true positives were consistent in patients over the study period. The take-home message from the study is that the high sensitivity of Medtronics implantable loop recorders means that they are good at detecting possible AF, but their findings must be reviewed and confirmed before being acted upon. There are high rates of false positives, but the results can be easily adjudicated by electrophysiologists as evidenced by our observer agreement, which was 100%. These strips need to be adjudicated by somebody, and not taken at face value, said investigator Dr. Spencer Maddox, an Emory resident. The devices look mainly at RR intervals and the presence or absence of P waves. Runs of 2 minutes are required for AF. One of the issues in the study was that T waves were identified as QRS complexes, which changed the RR interval and trigged the device to report AF, he said. Medtronic could reduce the false positive rate by, for instance, extending the run req Continue reading >>

Miniaturized Reveal Linq Insertable Cardiac Monitoring System: First-in-human Experience

Miniaturized Reveal Linq Insertable Cardiac Monitoring System: First-in-human Experience

Volume 12, Issue 6 , June 2015, Pages 1113-1119 Miniaturized Reveal LINQ insertable cardiac monitoring system: First-in-human experience Author links open overlay panel HelmutPrerfellnerMD, FHRS* The Reveal LINQ is a miniaturized insertable cardiac monitor (ICM) with wireless telemetry for remote monitoring of patients with suspected arrhythmias. The primary objective of this study was to evaluate the functionality of the Reveal LINQ system by measuring R-wave sensing and data transmission. The Reveal LINQ Usability Study was a nonrandomized, prospective, multicenter trial. The study enrolled 30 patients with any indication for an ICM. Data were collected at baseline, implantation, and 1-month follow-up visits and through daily wireless transmissions. Thirty patients were enrolled and had a Reveal LINQ device implanted. The mean age was 55 15 years. All patients had successful implantation of the ICM in one of the recommended locations. Ease of implantation procedure was rated as easy or very easy for 90% of implantations. R-wave amplitudes were 0.584 0.325 mV at implantation and 0.596 0.336 mV at 1 month (P = .8). Automatic transmissions were successful 79.5% (69.5%86.9%) of the time. Transmission failures that caused a delay in data transfer occurred because of incomplete data reception or patients being out of range in 45% and 42% of instances, respectively. For all patients, transmission failures were followed by successful automated or manual transmission of information on a subsequent day. The devices stored 217 arrhythmic episodes during 30 days of follow-up, identified as atrial fibrillation (n = 111), asystole (n = 95), bradycardia (n = 4), fast ventricular tachycardia (n = 1), and ventricular tachycardia ( n = 6). No serious procedure- or system-related adver Continue reading >>

Medtronic's New Reveal Linq Icm Gets Fda 510(k) Clearance

Medtronic's New Reveal Linq Icm Gets Fda 510(k) Clearance

Medtronic's New Reveal LINQ ICM Gets FDA 510(k) Clearance March 15, 2017, 10:14:00 AM EDT By Zacks Equity Research, Zacks.com Medical device major, Medtronic plc MDT recently received the U.S. FDA 510(k) clearance for its Reveal LINQ Insertable Cardiac Monitor (ICM) with TruRhythm Detection. The device is an advanced cardiac monitor with improved accuracy to better identify abnormal heartbeats. Notably, Medtronic's Cardiac & Vascular Group has been leading innovation in cardiac monitoring for a long time, including Reveal, the world's first loop recorder and Reveal LINQ, the world's smallest ICM. The company collaborates with a number of clinicians to redesign algorithms and improve detection quality of cardiac monitoring devices. ICMs basically help physicians to better manage patients at risk for cardiac arrhythmias. Addition of TruRhythm Detection to the Reveal LINQ ICM enables physicians to take quick and accurate decisions while dealing with patients. Medtronic PLC Price | Medtronic PLC Quote Compared to the predecessor Reveal LINQ ICM, the latest one reduces false heart beat detections by 49%. The device also features the atrial fibrillation (AF - an irregular and often very fast heart rate) algorithm, which learns and adapts to a patient`s heart rhythm over time. An added advantage of the new ICM is that it allows physicians to wirelessly monitor a patient's heartbeat for up to three years at a stretch. The device communicates wirelessly with a patient bedside monitor that uploads device data to the Medtronic CareLink network. Given the huge and growing cardiac monitoring market, we believe the latest FDA approval is a major positive for Medtronic. As per a recent MarketsandMarkets report, the global cardiac monitoring market is projected to reach a worth of $28 Continue reading >>

Medtronic Reveal Linq Insertable Cardiac Monitor

Medtronic Reveal Linq Insertable Cardiac Monitor

Australian Government Department of Health Medtronic Reveal LINQ insertable cardiac monitor Hazard alert - potential for premature replacement alert Consumers and health professionals are advised that Medtronic Australasia, in consultation with the TGA, has issued a hazard alert for the Medtronic Reveal LINQ insertable cardiac monitor (ICM). Medtronic Reveal LINQ ICM is a small medical device that is inserted just beneath the skin in the chest. It continuously monitors cardiac information and records the occurrence of abnormal heart rhythms. The device can automatically send this information to the doctor via wireless transmission. It has been identified that the Recommended Replacement Time (RRT) alert of a small subset of these devices may trigger prematurely. However, battery capacity is not affected by this issue and the device will continue to work correctly. Medtronic Reveal LINQ ICMs are normally expected to last an average of three years. Thirty days after an RRT alert triggers, the device will display an End of Service (EOS) status and automatic wireless alerts and transmissions are disabled. Patients can still send manual remote transmissions, which allow the doctor to continue to receive alerts and stored device data. Please note that this issue is not expected to occur until at least 200 days (six and a half months) after implantation. A software update is being prepared to address the premature RRT alert. There have been no reports of complications or injuries as a result of this issue in Australia or overseas. If you or someone you care for has a Medtronic Reveal LINQ ICM, please be aware of this issue. Medtronic Australasia estimates that fewer than 4% of patients who have a Medtronic Reveal LINQ ICM may experience a premature RRT alert. If you receive a Continue reading >>

Clinical Impact, Safety, And Accuracy Of The Remotely Monitored Implantable Loop Recorder Medtronic Reveal Linqtm

Clinical Impact, Safety, And Accuracy Of The Remotely Monitored Implantable Loop Recorder Medtronic Reveal Linqtm

Clinical impact, safety, and accuracy of the remotely monitored implantable loop recorder Medtronic Reveal LINQTM Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy Search for other works by this author on: Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy Search for other works by this author on: Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy Search for other works by this author on: Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy Search for other works by this author on: Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy Search for other works by this author on: Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy Search for other works by this author on: Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto-TN, Italy Corresponding author. Tel: +39 0464 403456; fax: +39 0464 404006. E-mail address: [email protected] Search for other works by this author on: Massimiliano Maines, Alessandro Zorzi, Giancarlo Tomasi, Carlo Angheben, Domenico Catanzariti, Lucio Piffer, Maurizio Del Greco; Clinical impact, safety, and accuracy of the remotely monitored implantable loop recorder Medtronic Reveal LINQTM, EP Europace, , eux187, Implantable loop recorders (ILR) are indicated in a variety of clinical situations when extended cardiac rhythm monitoring is needed. We aimed to assess the clinical impact, safety, and accuracy of the new Medtronic Reveal LINQTM ILR that can be inserted outside the electrophysiology (EP) laboratory and r Continue reading >>

Migration Of An Implantable Loop Recorder Into The Pleural Space

Migration Of An Implantable Loop Recorder Into The Pleural Space

Migration of an implantable loop recorder into the pleural space The Valley Hospital Health System, Ridgewood, New Jersey, and New York, New York Mark W. Preminger: [email protected] Address reprint requests and correspondence: Dr Mark W. Preminger, The Valley Hospital Health System, One Linwood Ave, Paramus, NJ 07652.The Valley Hospital Health SystemOne Linwood AveParamusNJ07652 [email protected] Received 2017 Apr 22; Revised 2017 Jul 4; Accepted 2017 Jul 18. Keywords: Cardiac implantable electronic device, Complications, Implantable loop recorder, Atrial fibrillation, Anticoagulation Copyright 2017 Heart Rhythm Society. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (Implantable loop recorders (ILRs) are most commonly used in patients with unexplained palpitations or syncope as well as suspected or known atrial fibrillation. The device most commonly being used today is the Medtronic Reveal LINQ (Minneapolis, MN); with a volume of <1.2 cc, it is designed for insertion using a greatly simplified technique. Specifically, the ILR is provided preloaded into an insertion tool that is used to deliver the device subcutaneously through a small incision, which is then closed using surgical glue, surgical tape, sutures, or staples. 1 The LINQ Usability study provided first in-human experience in an initial cohort of 30 patients followed for a month. 2 The only remarkable findings were implant site pain in 2 patients and a superficial wound infection in 2 patients. In this case report, we describe a patient in whom the ILR progressively migrated from the subcutaneous into the left pleural space. A 78-year-old man with hypertension, hyperlipidemia, and obstructive sleep apnea presented with an inferior wall myocardial infarctio Continue reading >>

Medtronic | Medtronic Reveal Linq | Medtech[y] Message Boards

Medtronic | Medtronic Reveal Linq | Medtech[y] Message Boards

Yea, I've seen these hanging around my customer's offices. They were put there by the young, inexperienced rep you hired for the territory. Medtronic takes the chintzy route by hiring ex-pharma reps who aren't properly trained and then those same reps drop off signs that promote the procedure as safe. I'm wondering if they told the patient who recently bled out on the table the same story? Of all procedures, a patient DYING with LINQ should never happen but it did. Yea, I've seen these hanging around my customer's offices. They were put there by the young, inexperienced rep you hired for the territory. Medtronic takes the chintzy route by hiring ex-pharma reps who aren't properly trained and then those same reps drop off signs that promote the procedure as safe. I'm wondering if they told the patient who recently bled out on the table the same story? Of all procedures, a patient DYING with LINQ should never happen but it did. Recent comments about LINQ from Gary Ellis: Yeah, let me, I mean firstly I'll, even with, as I mentioned with LINQ, it was, it came from $100 million to $150 million business to its annualized $500,000 [ph] million plus now within over the last 18 months. So we were adding couple of $100 million, $200 million to $250 million over the last couple of years in LINQ revenue, big growth driver for Medtronic. But LINQ itself as it now happens to be $1 billion business growing 30%. It's still adding $150 million of incremental revenue. So the idea is that, that growth that we've been getting from LINQ all of a sudden goes away it's not true. I mean it might be somewhat muted but it is still very strong. TAVR, the same way. I mean the reality is CoreValve, now with Evolut R, the growth rate in Transcatheter market is not, has not slowed down. We're just e Continue reading >>

Reveal Linq Monitor | Oliver Segal Cardiologist

Reveal Linq Monitor | Oliver Segal Cardiologist

We schedules dates for you to routinely send information from your device to us using your MyCareLink monitor (usually every 3 months) Device information is also sent automatically for the Reveal Linq device while you sleep if abnormal heart rhythms are detected Device information is sent automatically from the remote monitor to a secure computer server I review the device information on a secure website If you feel palpitations or have just passed out, you can use the device activator, or Reveal Patient Assistant, to instruct the device to store information from the previous 7.5-15 minutes (depending on device programming). The Reveal Patient Assistant is a hand-held, battery-operated device about the size of a deck of cards. When placed over the Reveal Linq device and the button pressed, it triggers the device to storethe previous 7.5-15 minutes of your heart rhythm and mark the place on the heart record when your fainting or other symptoms occurred. If successful, a green light illuminates to confirm. Please note, the Reveal Linq device will also automatically record abnormal heart rhythms without you needing to use the Reveal Patient Assist, but it will not store periods of normal heart rhythm when you may have fainted or had other symptoms and that is why it is important to always use the Assistant, if possible. The Patient Assistant itself does not transmit or store heart information The Patient Assistant can be used up to 4 times each day; the 5th time it will overwrite the first patient-saved episode It is recommended youcarry the Patient Assistant at all times.If youcant get to the Patient Assistant within a few minutes of symptoms, youshould simply write down the day and time of these symptoms to share with me at a follow-up clinic. The Reveal Patient Assista Continue reading >>

Medtronic Mycarelink Series Frequently Asked Questions Manual Page 4

Medtronic Mycarelink Series Frequently Asked Questions Manual Page 4

Q: Why does it take a while before the blue cellular signal A: At certain times, for example the first time the monitor starts Q: What is the date that appears on the LCD screen? A: The date shown on the screen is the last time scheduled A: This is the "interrogation in progress" screen for patients with Q: Why does the monitor keep showing the 5704 error code, even after A: If your monitor is still showing this error after moving it, try unplugging the monitor Q: What does the image of the cloud and arrow pointing at the monitor mean? A: This screen indicates that the monitor is looking for or receiving a software up or has traveled to a new location, the monitor needs to register with the cell towers before it can send or receive any information. The registration process can take a bit longer the first time; however, after that the monitor remembers the settings used, so subsequent connections to the cellular information was successfully sent from your heart device to your clinic. This date will appear when information is sent for Reveal LINQ ICMs. This screen will notify patients that a transmission is in progress; patients with a Reveal LINQ ICM should not interrupt this nightly transmission when they check their monitor. If patients see this screen, they shouldn't do anything. The monitor will continue to listen for Reveal LINQ ICM nightly wireless data and send it to the CareLink Network. The screen will go blank after 5 minutes. IMPORTANT: Patients should NOT press the "Accept" button or the "X" button on the screen, as this will cancel the wireless listening and display the start-up screen. and then plug it in again. You can also try changing the orientation of the monitor update. The animated Software Update screen typically displays for about 10-15 minutes be Continue reading >>

Medtronic's Tiny Implanted Cardiac Monitor Gets Approval

Medtronic's Tiny Implanted Cardiac Monitor Gets Approval

Medtronic's tiny implanted cardiac monitor gets approval The Reveal Linq implantable cardiac monitor is one-third the size of a AAA battery and can store data for up to three years. Its a device that even Medtronic Inc. officials admit is a little James Bond. But the tiny wireless cardiac monitor that doctors slip just beneath the skin with a syringe-like device is expected to make a very real impact for doctors and patients. Called the Reveal Linq ICM, the tinier-than-a-battery device can tell doctors if fainting or dizziness is because of an abnormal heart rhythm. It takes 30 seconds and youre done, Pat Mackin, president of Medtronics cardiac rhythm disease management business, said of the time it takes to implant. Fridley-based Medtronic on Wednesday announced the global launch of the device, about one-third the size of a AAA battery in volume and about 80 percent smaller than similar devices on the market. The company has received regulatory approval in the United States and Europe. The device is inserted through a 1-centimeter incision. There is no need for general anesthetic, and it continuously and wirelessly monitors the heart for up to three years. There is a huge void for this type of technology, said Dr. Rod Passman, professor and associate director of cardiac electrophysiology at the Northwestern University Feinberg School of Medicine in Chicago. This device is good at picking up all abnormal rhythms of the heart. Indicated for use as a diagnostic tool for people suffering from unexplained fainting, dizziness, palpitations or chest pain, Reveal also will help doctors determine if a patient has atrial fibrillation, Passman said. The abnormal heart rhythm, connected to stroke, can be very intermittent and asymptomatic. We usually only check for a few days and Continue reading >>

Medtronics Reveal Linq Detects Atrial Fibrillation At Higher Rate Than Previously Recorded

Medtronics Reveal Linq Detects Atrial Fibrillation At Higher Rate Than Previously Recorded

Medtronics Reveal LINQ detects atrial fibrillation at higher rate than previously recorded Medtronic has announced one-year results from a real-world study of patients who had a cryptogenic stroke, or stroke of unknown cause. The study found that the Reveal LINQ insertable cardiac monitor (ICM) detected atrial fibrillation (AF) at a greater rate than previously reported in a randomised controlled clinical trial (the CRYSTAL AF Study, published in The New England Journal of Medicine in 2014). The results from the observational real-world study were presented at the 68th American Academy of Neurology Annual Meeting in Vancouver, Canada. The study evaluated 1,247 patients across the US to understand the incidence and duration of AF episodes in a large, real-world population of cryptogenic stroke patients with an ICM after one year of follow up and to compare the AF detection rates among these patients to those of the CRYSTAL AF Study. At 12 months, 1,737 AF episodes were detected in 192 patients, resulting in an AF detection rate of 16.3%. This represents a 32% relative increase compared to the rate observed in the CRYSTAL AF Study at the same time. The real-world study found that 72% of patients diagnosed with AF would have been undiagnosed if their cardiac monitoring had been limited to 30 days. In clinical practice, we continue to see increased AF detection rates using the insertable cardiac monitor compared to the rigorously-controlled CRYSTAL AF study, says co-author John Rogers, a cardiologist at Scripps Clinic in La Jolla, USA. What is most significant, however, is that the vast majority of patients had their first AF episode beyond the range of 30-day conventional monitoring, reinforcing the need to re-evaluate the standard AF monitoring guidelines for cryptogenic Continue reading >>

Anzcdacc Advisory Notice 7 March 2016 Medtronic Reveal Linq Insertable Cardiac Monitor (icm)

Anzcdacc Advisory Notice 7 March 2016 Medtronic Reveal Linq Insertable Cardiac Monitor (icm)

Device: Medtronic Reveal LINQ Insertable Cardiac Monitor (ICM)Model LNQ11 8042, 8042B, 8042U Number at risk in Australia and New Zealand: Numerous Risk: There is the potential for an issue with the sensitivity of an algorithm used in the RevealLINQ ICM that may prematurely trigger the RRT (Recommended Replacement Time). As of February 12, 2016, Medtronic has observed an occurrence rate of 0.45% of devices experiencing this issue. Battery capacity is not affected and the device will continue to support data collection and manual data transmissions. At 30 days after RRT status is reached, Reveal LINQ devices will display an End of Service (EOS) status at which time the device disables automatic wireless alerts and transmissions. Patients will still be able to transmit remote manual transmissions allowing clinics to receive alerts and stored device data. Due to the design of the RRT algorithm, devices are not susceptible to this issue until 200 days (6.5 months) post-implant. Description: Medtronic has identified a performance issue that affects the RRT alert which occurs prematurely in of a small subset of these devices. This occurs when there is sufficient battery longevity and the device will continue to function but requires manual transmissions when RRT changes to EOS. Presentation: Patients will not present independently however interrogation by CARE link will highlight premature RRT. The patient will be required to transmit manually as automatic transmissions will no longer work at EOS Advice: The device is functioning normally and should not be replaced. The patients management should continue normally as before. Medtronic will release a software update to prevent and correct the issue. Continue reading >>

Initial Experience With The Reveal Linq Insertable Cardiac Monitor

Initial Experience With The Reveal Linq Insertable Cardiac Monitor

Initial Experience with the Reveal LINQ Insertable Cardiac Monitor John D. Rogers, MD, FACC, Director, Cardiac Pacing and Tachyarrhythmia Device Therapy, Scripps Clinic Our patient is a 76-year-old woman with a history of hypertension and adult-onset diabetes. Recently she suffered a stroke that has left her with residual right-sided weakness. An extensive inpatient workup revealed no etiology for her stroke. This workup included MRI /MRA imaging, carotid arterial Doppler studies, and transthoracic and transesophageal echocardiograms. She was evaluated on telemetry for 72 hours which remained normal. She was discharged to home with a 30-day external loop recorder which was also normal. This is not uncommon it is estimated that perhaps up to 25% of non-hemorrhagic strokes will be eventually classified as cryptogenic or stroke of unknown cause.1 Recent evidence from the CRYSTAL-AF study presented at the International Stroke Conference 2014 demonstrated up to 30% of patients with cryptogenic stroke may have atrial fibrillation as the cause of their stroke (Figure 1). Continuous heart rhythm monitoring with an implanted cardiac monitor demonstrated superior detection of atrial fibrillation compared to standard follow-up methods (e.g., ECG, Holter monitor, external loop recorder) (Figure 1). Detecting atrial fibrillation in these patients allows us as to alter therapy to prevent further strokes (placing patients on oral anticoagulation).2 In February of this year, the FDA approved Medtronics subcutaneous insertable loop recorder, the Reveal LINQ cardiac monitor. Like its predecessor, the Reveal XT, the LINQ maintains a three-year battery life and the ability to detect atrial fibrillation. However, LINQ has a number of revolutionary advancements. This new device is 87% small Continue reading >>

Remote Monitoring | Oliver Segal Cardiologist

Remote Monitoring | Oliver Segal Cardiologist

We schedules dates for you to routinely send information from your device to us using your MyCareLink monitor (usually every 3 months) Device information is also sent automatically for the Reveal Linq device while you sleep if abnormal heart rhythms are detected Device information is sent automatically from the remote monitor to a secure computer server I review the device information on a secure website Using the Medtronic MyCareLink Monitor to manually send information It is often useful for you to send a manual transmission using the MyCareLink monitor. This ensures all the devices information is transmitted and clears the device for new information. This is the same process you will need to do when first setting up the monitor or if you take it abroad. Please follow the instructions below for how to do this: Make sure the MyCareLink monitor is plugged into a power socket. The MyCareLink will show it is receiving a 3G wireless phone signal by showing a picture of an aerial mast and some blue bars. An arrow will point to the grey button Place the transmission module over your device and watch the MyCareLink monitor screen for the green bar. This shows the device is relaying information. The module can be replaced in its dock. When the green tick is displayed, the information has been successfully sent to the CareLink portal and will be available for me to examine. If you have an ICD (defibrillator), CRT-D (biventricular ICD) or Reveal Linq device, information from your device is sent to the monitor every night at approximately 2am, as long as you are within 2m of the monitor and there is a cellular signal. This is why we ask patients to locate the monitor in their bedroom on their bedside table if possible. Any device malfunctions that are detected generate an email Continue reading >>

The Life-saving Heart Device That Costs 2,000 And Tells Your Doctor When There's A Problem

The Life-saving Heart Device That Costs 2,000 And Tells Your Doctor When There's A Problem

The life-saving heart device that costs 2,000 and tells your doctor when there's a problem AT least 30 Islanders have benefited from a revolutionary new health procedure that allows doctors to accurately diagnose heart conditions that they may have previously missed. The pioneering heart monitoring device, known as a Reveal Linq monitor, utilises wireless technology, usually reserved for wi-fi internet connections, to send information about a patient's heart directly to their doctor. Each monitor costs 2,000 compared to 1,200 for the old version but that is likely to come down in price as more people are fitted with them. It took about four years to develop the new technology, which was made by Medtronic.[/breakout] Currently the technology, which is so small it takes less than a minute to install and sits just under the skin near the heart, is implanted in theatre but staff say the procedure could be moved to outpatients by the end of the year. A monitor was first fitted in Jersey in February last year when then 77-year-old Doreen Van Der Vliet became only the third person in Britain to be given the device. Now, 12 months on, more than 30 Islanders have had the device implanted. The Hospital's consultant cardiologist, Dr Andrew Mitchell, said the technology had proved invaluable and that many illnesses, including at least one rare heart condition, had been diagnosed using the technology. Dr Mitchell said that the devices, which have been developed by UK firm Medtronic, are usually implanted into patients who had suffered two or more unexplained blackouts. 'It is an extremely helpful bit of kit,' he said. 'Before this we would have had to go through all sorts of examinations and had to wire people up to ECGs, which they would have to walk around with. 'If people black Continue reading >>

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