Adapting detection sensitivity based on evidence of irregular sinus arrhythmia to improve atrial fibrillation detection in insertable cardiac monitors

Pürerfellner, Helmut; Sanders, Prashanthan; Sarkar, Shantanu; Reisfeld, Erin; Reiland, Jerry; Koehler, Jodi; Pokushalov, Evgeny; Urban, L.; Dekker, Lukas

doi:10.1093/europace/eux272

Cited by 33 publications

(39 citation statements)

References 18 publications

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“…Clinical studies demonstrated that the true positive rate for AF detection is dependent on the AF prevalence in the study cohorts, the programmed sensitivity of AF algorithm, as well as the duration of detected AF episodes 2,4 . The TruRhythm Detection for Reveal LINQ applies an adaptive p‐wave evidence algorithm to further reduce false AF detection with minimal reduction in sensitivity 3 . The base algorithm in Confirm Rx is similar to the prior Confirm ICM.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 The TruRhythm Detection for Reveal LINQ applies an adaptive p-wave evidence algorithm to further reduce false AF detection with minimal reduction in sensitivity. 3 The base algorithm in Confirm Rx is similar to the prior Confirm ICM. The details of this algorithm have been described in a previous study.…”

Section: Freedom From Arrhythmias and Time To Diagnosismentioning

confidence: 99%

“…1 The TruRhythm Detection software in Reveal LINQ, released in 2017, applied a dual-sense algorithm to reduce false bradycardia and pause episode detections 2 and a more adaptive p-wave evidence algorithm to reduce false AF episode detections. 3…”

Section: Introductionmentioning

confidence: 99%

“…With the intent of reducing false positive detections while maintaining sensitivity, both ICMs have introduced algorithm enhancements to the device. The TruRhythm Detection software in Reveal LINQ, released in 2017, applied a dual‐sense algorithm to reduce false bradycardia and pause episode detections 2 and a more adaptive p‐wave evidence algorithm to reduce false AF episode detections 3 . The SharpSense Technology software recently introduced in Confirm Rx contains four additional discriminators to reduce false bradycardia episodes due to undersensing, false pause episodes due to undersensing, and loss of tissue‐electrode contact, and false AF episode with detectable p‐waves.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of arrhythmia detection in implantable cardiac monitors: A prospective randomized clinical trial comparing Reveal LINQ and Confirm Rx

Jaffe

Castellani

et al. 2020

Pacing Clinical Electrophis

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Background: Implantable cardiac monitors (ICMs) are increasingly used to detect arrhythmias in various clinical situations. However, the data transmission time and accuracy of detecting cardiac arrhythmias are unclear. Objective: The objective of this study was to compare the efficiency of data transmission and arrhythmia detection accuracy of the Reveal LINQ with TruRhythm Detection with the Confirm Rx with SharpSense Technology. Methods: In this prospective study, 142 patients were randomized 1:1 to receive Reveal LINQ or Confirm Rx ICM system. Arrhythmic events include atrial fibrillation (AF), pauses, and bradycardia. Data transmission time is defined as the time from event occurrence to physician notification. All the arrhythmic events are adjudicated for accuracy. Results: A total of 3510 events were transmitted in 61 patients over 7.1 ± 3.5 months. The transmission time both for all events (448 ± 271 vs 610 ± 515 minutes, P = .02) and for patient activated triggers (24 ± 103 vs 475 ± 426 minutes, P < .0001) was significantly shorter in the Confirm Rx group. The total number of events was also higher in the Confirm Rx group (25.5 ± 45.6 vs 0.9 ± 1.1 events per patient-month, P < .01), which is likely due to event transmission setting differences between the two groups. Kaplan-Meier analysis showed that the Confirm Rx group detected true arrhythmic episodes sooner with higher percentage of diagnosed patients during 6-month followup (P = .006). Patient-averaged true positive detection rates were not statistically significant in the two groups (Reveal LINQ vs Confirm Rx, AF: 52% vs 38%; bradycardia: 67% vs 59%; pause: 24% vs 20%; tachycardia: 81% vs 94%). Conclusion: Compared to the Reveal LINQ, Confirm Rx has shorter event transmission time, more frequent event detections, shorter duration to diagnose true This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Section: Discussionmentioning

confidence: 99%

Section: Freedom From Arrhythmias and Time To Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Accuracy of arrhythmia detection in implantable cardiac monitors: A prospective randomized clinical trial comparing Reveal LINQ and Confirm Rx

Jaffe

Castellani

et al. 2020

Pacing Clinical Electrophis

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“…The latest algorithms of atrial fibrillation implemented in ICMs are characterised by over 99% sensitivity and a positive predictive value of 95% [37].…”

Section: Ecg Monitoringmentioning

confidence: 99%

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

Farkowski

Karliñski

Kaźmierczak

et al. 2018

Neurol Neurochir Pol.

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Introduction. Stroke remains one of the main causes of death and the most common cause of long-term disability in adults. Embolic strokes of undetermined source (ESUS) amount to a significant proportion of all ischaemic strokes. Detection of atrial fibrillation (AF) in this group of patients would allow for a major therapeutic decision to switch from antiplatelets to oral anticoagulants and therefore significantly reduce the risk of recurrence. State of the Art. Current technology allows long-term continuous ECG monitoring with different systems, including implantable cardiac monitors (ICM). However, in Poland lack of reimbursement does not allow their use in everyday clinical practice. Clinical Implications. This is a statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of ICM in patients after ischaemic embolic strokes of undetermined source. The aim was to develop reasonable and comprehensive guidance on how to select and manage candidates for ICM in order to obtain the maximum benefit for Polish public health. Future Directions. This expert opinion is not intended as a guideline but it provides advice as to how to optimise the potential use of ICM in patients after ESUS in the Polish setting.

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Atrial Fibrillation In Patients With Stroke Attributed to Large- or Small-Vessel Disease

Bernstein,

Kamel,

Granger

et al. 2023

JAMA Neurol

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ImportanceThe STROKE AF study found that in patients with prior ischemic stroke attributed to large-artery atherosclerotic disease (LAD) or small-vessel occlusive disease (SVD), 12% developed AF over 1 year when monitored with an insertable cardiac monitor (ICM). The occurrence over subsequent years is unknown.ObjectivesTo compare the rates of AF detection through 3 years of follow-up between an ICM vs site-specific usual care in patients with prior ischemic stroke attributed to LAD or SVD.Design, Setting, and ParticipantsThis multicenter, randomized (1:1) clinical trial took place at 33 sites in the US with enrollment between April 2016 and July 2019 and 3-year follow-up through July 2022. Eligible patients were aged 60 years or older, or aged 50 to 59 years with at least 1 additional stroke risk factor and had an index ischemic stroke attributed to LAD or SVD within 10 days prior to ICM insertion. Of the 496 patients enrolled, 492 were randomized and 4 were excluded.InterventionsICM monitoring vs site-specific usual care.Main Outcomes and MeasuresThe prespecified long-term outcome of the trial was AF detection through study follow-up (up to 3 years). AF was defined as an episode lasting more than 30 seconds, adjudicated by an expert committee.ResultsIn total, 492 patients were randomized and included in the analyses (median [IQR] age, 66 [60-74] years; 307 men [62.4%] and 185 women [37.6%]), of whom 314 completed 3-year follow-up (63.8%). The incidence rate of AF at 3 years was 21.7% (46 patients) in the ICM group vs 2.4% (5 patients) in the control group (hazard ratio, 10.0; 95% CI, 4.0-25.2; P &lt; .001).Conclusions and RelevancePatients with ischemic stroke attributed to LAD or SVD face an increasing risk of AF over time and most of the AF occurrences are not reliably detected by standard medical monitoring methods. One year of negative monitoring should not reassure clinicians that patients who have experienced stroke will not develop AF over the next 2 years.Trial RegistrationClinicalTrials.gov Identifier: NCT02700945

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Adapting detection sensitivity based on evidence of irregular sinus arrhythmia to improve atrial fibrillation detection in insertable cardiac monitors

Cited by 33 publications

References 18 publications

Accuracy of arrhythmia detection in implantable cardiac monitors: A prospective randomized clinical trial comparing Reveal LINQ and Confirm Rx

Accuracy of arrhythmia detection in implantable cardiac monitors: A prospective randomized clinical trial comparing Reveal LINQ and Confirm Rx

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

Atrial Fibrillation In Patients With Stroke Attributed to Large- or Small-Vessel Disease

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