Incidence of false-positive transmissions during remote rhythm monitoring with implantable loop recorders

Afzal, Muhammad R.; Mease, Julie; Koppert, Tanner; Okabe, Toshimasa; Tyler, Jaret; Houmsse, Mahmoud; Augostini, Ralph; Weiss, Raul; Hummel, John D.; Kalbfleisch, Steven J.; Daoud, Emile G.

doi:10.1016/j.hrthm.2019.07.015

Cited by 67 publications

(93 citation statements)

References 9 publications

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“…However, it should be noted that a high prevalence of sensing issues has been reported in studies that used standard length dipole (<50 mm) ICMs. Afzal MR et al on a cohort of 559 patents implanted with a miniaturized ICM found an incidence of bradyarrhythmia false positives during remote monitoring ranging from 46% to 86% 14 . Since the mean R‐wave amplitude reported for devices with standard length dipole ranged from 0.45 to 0.59 mV, 15,16 a potential correlation between signal amplitude and burden of undersensing episodes may be assumed.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting signal quality in implantable cardiac monitors with long sensing vector

Forleo

Amellone

Sacchi

et al. 2021

Journal of Arrhythmia

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Purpose Electrical artefacts are frequent in implantable cardiac monitors (ICMs). We analyzed the subcutaneous electrogram (sECG) provided by an ICM with a long sensing vector and factors potentially affecting its quality. Methods Consecutive ICM recipients underwent a follow‐up where demographics, body mass index (BMI), implant location, and surface ECG were collected. The sECG was then analyzed in terms of R‐wave amplitude and P‐wave visibility. Results A total of 84 patients (43% female, median age 68 [58‐76] years) were enrolled at 3 sites. ICMs were positioned with intermediate inclination (n = 44, 52%), parallel (n = 35, 43%), or perpendicular (n = 5, 6%) to the sternum. The median R‐wave amplitude was 1.10 (0.72‐1.48) mV with P waves readily visible in 69.2% (95% confidence interval, CI: 57.8%‐79.2%), partially visible in 23.1% [95% CI: 14.3%‐34.0%], and never visible in 7.7% [95% CI: 2.9%‐16.0%] of patients. Men had higher R‐wave amplitudes compared to women (1.40 [0.96‐1.80] mV vs 1.00 [0.60‐1.20] mV, P = .001), while obese people tended to have lower values (0.80 [0.62‐1.28] mV vs 1.10 [0.90‐1.50] mV, P = .074). The P‐wave visibility reached 86.2% [95% CI: 68.3%‐96.1%] in patients with high‐voltage P waves (≥0.2 mV) at surface ECG. The sECG quality was not affected by implant site. Conclusion In ordinary clinical practice, ICMs with long sensing vector provided median R‐wave amplitude above 1 mV and reliable P‐wave visibility of nearly 70%, regardless of the position of the device. Women and obese patients showed lower but still very good signal quality.

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Section: Discussionmentioning

confidence: 99%

Factors affecting signal quality in implantable cardiac monitors with long sensing vector

Forleo

Amellone

Sacchi

et al. 2021

Journal of Arrhythmia

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“…(2) Continuous arrhythmia monitoring was not performed that could have led to underestimation of recurrent events. However, studies have shown continuous arrhythmia monitoring to have high rates of false positive results and the detection rate to be similar to that of discontinuous monitoring 22 . (3) In this series, non‐PV triggers were ablated based on the preference of the operator, thereby introducing some potential bias.…”

Section: Limitationsmentioning

confidence: 99%

Arrhythmia profile and ablation‐outcome in elderly women with atrial fibrillation undergoing first catheter ablation

Natale

Mohanty

Trivedi

et al. 2021

Pacing Clinical Electrophis

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Background This study evaluated the arrhythmia profile and ablation outcome in women with atrial fibrillation (AF) aged ≥75 years. Methods A total of 573 consecutive female patients undergoing first AF ablation were classified into group 1: ≥75 years (n = 221) and group 2: < 75 years (n = 352). Isolation of PVs, posterior wall and superior vena cava was performed in all. Non‐PV triggers from other areas were ablated based on operator's discretion. Results Group 1 had higher prevalence of hypertension (154 (69.7%) vs. 188 (53.4%), p < .001) and non‐paroxysmal AF (136 (61.5%) vs. 126 (35.8%), p < .001). Non‐PV triggers were detected in 194 (87.8%) patients from group 1 and 143 (40.6%) from group 2 (p < .001) and were ablated in 152 (68.8%) and 114 (32.4%) from group 1 and 2 respectively. Remaining patients (group 1: 69/221 and group 2: 238/352) received no additional ablation. At 4 years, 109 (49.3%) and 185 (52.6%) from group 1 and 2, respectively, were arrhythmia‐free, p = .69. When stratified by ablation‐strategy, success‐rate was similar across groups in patients receiving non‐PV trigger ablation (96 (63.2%) in group 1 and 76 (66.7%) in group 2, p = .61), whereas it was significantly lower in group 1 patients not receiving additional ablation compared to those from group 2 (13 (18.8%) vs. 109 (45.8%), p < .001). Conclusion Non‐paroxysmal AF was more common in women aged ≥75 years. Furthermore, significantly higher number of non‐PV triggers were detected in elderly women and ablation of those provided similar ablation success as that in women aged < 75 years.

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“…Various protocols exist for the ILR implantation. ILR is recommended to be inserted at 45° or vertical angle within second to fourth intercostal space, 2 cm from the left border of the sternum 8 , 9 . However, there is no evidence that the position or angle of insertion in the given protocol maximizes QRS complex or P‐wave amplitude for ILR recording.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the determining factors of detectable P‐wave and amplitude of QRS complex sensed by implantable loop recorder

Ahn

Ryu

et al. 2021

Journal of Arrhythmia

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Background Determining factors for sufficient QRS amplitude and discernible P‐wave sensing in implantable loop recorder (ILR) are unknown. We aimed to investigate determining factors and ILR implantation angle that may improve QRS complex and P‐wave sensing in ILR. Methods We retrospectively reviewed 220 patients who underwent ILR implantation or follow‐up analysis. Patient demographic, clinical, echocardiography, electrocardiography, heart angle, and ILR angle data were collected as predictor variables. Associations between ILR QRS amplitude/P‐wave detectability and each predictor variable were investigated. Results Univariate linear regression showed that ILR QRS amplitude was significantly associated with age, height, ILR angle, and QRS amplitudes of 12‐lead electrocardiogram (ECG) (lead I, II, aVR [inverted aVR], aVF, V1–V6) and Holter ECG (lead V3, V5). Among discrete variables, only left ventricular hypertrophy (LVH) affected ILR QRS amplitude (P = .016). A multivariate linear regression analysis revealed that ILR angle (β = −0.008, P < .001), lead aVR amplitude (β = 0.469, P = .003), Holter lead V5 amplitude (β = 0.116, P = .049), Age (β = −0.005, P = .014), and LVH (β = 0.213, P = .031) were independent determinants of ILR QRS amplitude. Logistic regression revealed that heart angle significantly affected ILR P‐wave detectability (β = 0.12, P = .008). Multiple logistic regression revealed that heart angle (β = 0.121, P = .013) and lead V1 amplitude (β = 28.1, P = .034) were independent determinants of ILR P‐wave detectability. Conclusion ILR insertion angle, lead aVR QRS amplitude, Holter lead V5 QRS amplitude, age, and LVH are determinants of ILR QRS amplitude. Heart angle and lead V1 P‐wave amplitude of 12‐lead ECG are determinants of ILR P‐wave detectability.

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Incidence of false-positive transmissions during remote rhythm monitoring with implantable loop recorders

Cited by 67 publications

References 9 publications

Factors affecting signal quality in implantable cardiac monitors with long sensing vector

Factors affecting signal quality in implantable cardiac monitors with long sensing vector

Arrhythmia profile and ablation‐outcome in elderly women with atrial fibrillation undergoing first catheter ablation

Analysis of the determining factors of detectable P‐wave and amplitude of QRS complex sensed by implantable loop recorder

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