Diagnostic yield of an insertable cardiac monitor in a large patient population

Lau, Dennis H.; Pierre, Bertrand; Cabañas, Pilar; Martens, Eimo; Bisignani, Giovanni; Höfer, Daniel; Berruezo-Sanchez, Antonio; Eschalier, Romain; Mansourati, Jacques; Gaspar, Thomas; Sanfins, Víctor; Ērglis, Andrejs; Hain, Andreas; Papaioannou, Georgios; Cueno, Alessandro; Tscholl, Verena; Schrader, Jürgen; Deneke, Thomas

doi:10.1016/j.hroo.2022.11.005

Cited by 6 publications

(6 citation statements)

References 13 publications

(22 reference statements)

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“…In this study, we investigated the incidence of cardiac arrhythmias using ICM monitoring in a real-life population with heterogenous ICM indications for this device. Previous research has demonstrated that prolonged and continuous monitoring results in a significantly higher number of arrhythmic diagnoses compared with standard care 10–14 . Our findings indicate that, in addition to the anticipated arrhythmic findings based on the patient's profile at the time of ICM insertion, a considerable proportion of patients may also experience incidental arrhythmias.…”

Section: Discussionmentioning

confidence: 52%

“…Previous research has demonstrated that prolonged and continuous monitoring results in a significantly higher number of arrhythmic diagnoses compared with standard care. [10][11][12][13][14] Our findings indicate that, in addition to the anticipated arrhythmic findings based on the patient's profile at the time of ICM insertion, a considerable proportion of patients may also experience incidental arrhythmias. Available literature on incidental arrhythmias (e.g.…”

Section: Discussionmentioning

confidence: 66%

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Incidental and anticipated arrhythmic diagnoses in patients with an implantable cardiac monitor

Maines,

Rotondi,

Guarracini

et al. 2024

Journal of Cardiovascular Medicine

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Aims In this study, we investigated a cohort of unselected patients with various indications for an implantable cardiac monitor (ICM). Our main objectives were to determine the incidence of arrhythmic diagnoses, both anticipated and incidental in relation to the ICM indication, and to assess their clinical relevance. Methods We examined remote monitoring transmissions from patients with an ICM at four Italian sites to identify occurrences of cardiac arrhythmias. Concurrently, we collected data on medical actions taken in response to arrhythmic findings. Results The study included 119 patients, with a median follow-up period of 371 days. ICM indications were syncope/presyncope (46.2%), atrial fibrillation management (31.1%), and cryptogenic stroke (22.7%). In the atrial fibrillation management group, atrial fibrillation was the most common finding, with an incidence of 36% [95% confidence interval (CI) 22–55%] at 18 months. Rates of atrial fibrillation were not significantly different between patients with cryptogenic stroke and syncope/presyncope [17% (95% CI 7–40%) vs. 8% (95% CI 3–19%), P = 0.229]. For patients with cryptogenic stroke, the incidence of asystole and bradyarrhythmias at 18 months was 23% (95% CI 11–45%) and 42% (95% CI 24–65%), respectively, similar to estimates obtained for patients implanted for syncope/presyncope (P = 0.277 vs. P = 0.836). Overall, 30 patients (25.2%) required medical intervention following ICM-detected arrhythmias, predominantly involving atrial fibrillation ablation (10.9%) and medication therapy changes (10.1%). Conclusion In a real-life population with heterogeneous insertion indications, approximately 25% of patients received ICM-guided medical interventions within a short timeframe, including treatments for incidental findings. Common incidental arrhythmic diagnoses were bradyarrhythmias in patients with cryptogenic stroke and atrial fibrillation in patients with unexplained syncope.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 66%

Incidental and anticipated arrhythmic diagnoses in patients with an implantable cardiac monitor

Maines,

Rotondi,

Guarracini

et al. 2024

Journal of Cardiovascular Medicine

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“…These included diagnoses leading to pacing indication, such as conduction system disorders, but also atrial fibrillation or flutter, diagnosed in 37% of the population. Hence, the ILR provided a high diagnostic yield in terms of cardiac arrhythmias in patients with syncope, not restricted to arrhythmias directly related to syncope [ 12 , 13 , 14 , 15 , 17 , 19 , 35 , 36 ] but including other diagnoses with therapeutic implications such as atrial fibrillation. These findings are in line with other studies showing a high prevalence of atrial fibrillation in patients receiving an ILR.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are in line with other studies showing a high prevalence of atrial fibrillation in patients receiving an ILR. These studies not only included patients with cryptogenic stroke [ 37 , 38 , 39 , 40 ], but also patients with other indications such as syncope [ 19 , 35 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield and Clinical Implications of Implantable Loop Recorders in Patients with Syncope in Germany: A National Database Analysis

Mueller-Leisse,

Hillmann,

Iserloh

et al. 2024

JCM

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In patients with unexplained syncope, implantable loop recorders (ILR) are used to detect arrhythmias as a cause of syncope. This study aimed to assess the diagnostic yield and clinical implications arising from ILR implantation in patients with syncope in Germany. Secondary longitudinal data were obtained from a large German research database including anonymized data from nationwide statutory health insurances, representative for the German population. Patients ≥ 18 years with a diagnosis of syncope and ILR implantation between 2017 and 2018 were analyzed, and cardiac diagnoses and therapies during a follow-up period of two years assessed. Of 2,403,301 continuously insured persons in 2017–2018, 1360 (0.1%) received an ILR and 675 patients (45.6% female) were included. During follow-up, arrhythmias were diagnosed in 65.0%. The following antiarrhythmic therapies were established: pacemaker and defibrillator implantations in 20% and 1.5%, respectively, ablation therapy in 3.0%, and antiarrhythmic drug therapy in 4.7%. Aside from the diagnoses typically associated with syncope, atrial fibrillation or flutter was diagnosed in 37.0%, and anticoagulation therapy was initiated in 21.5%. There was a high diagnostic yield of arrhythmias following ILR implantation, leading to a relevant number of syncope-specific treatment. Arrhythmias not necessarily related to syncope were also diagnosed, leading to a high rate of anticoagulation therapy.

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“…Data for the present study were pooled from three clinical projects: the CERTITUDE registry, which is a real-world database of U.S. health insurance data and remote monitoring data ( 7 , 8 ), the BIO|MASTER.BIOMONITOR III study ( 9 , 10 ) (NCT04025710), and the BIO|STREAM.ICM study ( 9 , 10 ) (NCT04075084; the latter two with patients from eight European countries and Australia). In all three projects, ethics committee or competent authority approvals were obtained and patients consented to the scientific use of their data.…”

Section: Methodsmentioning

confidence: 99%

Implantable cardiac monitors: artificial intelligence and signal processing reduce remote ECG review workload and preserve arrhythmia detection sensitivity

Bisignani,

Cheung,

Rordorf

et al. 2024

Front. Cardiovasc. Med.

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IntroductionImplantable cardiac monitors (ICMs) provide long-term arrhythmia monitoring, but high rates of false detections increase the review burden. The new “SmartECG” algorithm filters false detections. Using large real-world data sets, we aimed to quantify the reduction in workload and any loss in sensitivity from this new algorithm.MethodsPatients with a BioMonitor IIIm and any device indication were included from three clinical projects. All subcutaneous ECGs (sECGs) transmitted via remote monitoring were classified by the algorithm as “true” or “false.” We quantified the relative reduction in workload assuming “false” sECGs were ignored. The remote monitoring workload from five hospitals with established remote monitoring routines was evaluated. Loss in sensitivity was estimated by testing a sample of 2000 sECGs against a clinical board of three physicians.ResultsOf our population of 368 patients, 42% had an indication for syncope or pre-syncope and 31% for cryptogenic stroke. Within 418.5 patient-years of follow-up, 143,096 remote monitoring transmissions contained 61,517 sECGs. SmartECG filtered 42.8% of all sECGs as “false,” reducing the number per patient-year from 147 to 84. In five hospitals, nine trained reviewers inspected on average 105 sECGs per working hour. This results in an annual working time per patient of 83 min without SmartECG, and 48 min with SmartECG. The loss of sensitivity is estimated as 2.6%. In the majority of cases where true arrhythmias were rejected, SmartECG classified the same type of arrhythmia as “true” before or within 3 days of the falsely rejected sECG.ConclusionSmartECG increases efficiency in long-term arrhythmia monitoring using ICMs. The reduction of workload by SmartECG is meaningful and the risk of missing a relevant arrhythmia due to incorrect filtering by the algorithm is limited.

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Diagnostic yield of an insertable cardiac monitor in a large patient population

Cited by 6 publications

References 13 publications

Incidental and anticipated arrhythmic diagnoses in patients with an implantable cardiac monitor

Incidental and anticipated arrhythmic diagnoses in patients with an implantable cardiac monitor

Diagnostic Yield and Clinical Implications of Implantable Loop Recorders in Patients with Syncope in Germany: A National Database Analysis

Implantable cardiac monitors: artificial intelligence and signal processing reduce remote ECG review workload and preserve arrhythmia detection sensitivity

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