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Fareh S, Nardi S, Argenziano L, Diamante A, Scala F, Mandurino C, Magnocavallo M, Poggio L, Scarano M, Gianfrancesco D, Palma F, Silvetti MS, Porcelli D, Racheli M, Montoy M, Charles P, Campari M, Valsecchi S, Lavalle C. Implantation of a novel insertable cardiac monitor: preliminary multicenter experience in Europe. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01821-y. [PMID: 38755520 DOI: 10.1007/s10840-024-01821-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The LUX-Dx™ is a novel insertable cardiac monitor (ICM) introduced into the European market since October 2022. PURPOSE The aim of this investigation was to provide a comprehensive description of the ICM implantation experience in Europe during its initial year of commercial use. METHODS The system comprises an incision tool and a single-piece insertion tool pre-loaded with the small ICM. The implantation procedure involves incision, creation of a device pocket, insertion of the ICM, verification of sensing, and incision closure. Patients receive a mobile device with a preloaded App, connecting to their ICM and transmitting data to the management system. Data collected at European centers were analyzed at the time of implantation and before patient discharge. RESULTS A total of 368 implantation procedures were conducted across 23 centers. Syncope (235, 64%) and cryptogenic stroke (34, 9%) were the most frequent indications for ICM. Most procedures (338, 92%) were performed in electrophysiology laboratories. All ICMs were successfully implanted in the left parasternal region, oriented at 45° in 323 (88%) patients. Repositioning was necessary after sensing verification in 9 (2%) patients. No procedural complications were reported, with a median time from skin incision to suture of 4 min (25th-75th percentiles 2-7). At implantation, the mean R-wave amplitude was 0.39 ± 0.30 mV and the P-wave visibility was 91 ± 20%. Sensing parameters remained stable until pre-discharge and were not influenced by patient characteristics or indications. Procedural times were fast, exhibited consistency across patient groups, and improved after an initial experience with the system. Operator Operator feedback on the system was positive. Patients reported very good ease of use of the App and low levels of discomfort after implantation. CONCLUSIONS LUX-Dx™ implantation appears efficient and straightforward, with favorable post-implantation sensing values and associated with positive feedback from operators and patients.
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Affiliation(s)
- S Fareh
- Department of Cardiology, Hôpital de La Croix Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Gd Rue de La Croix-Rousse, 69004, Lyon, France.
| | - S Nardi
- Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | | | - A Diamante
- Casa Di Cura "Villa Azzurra", Siracusa, Italy
| | - F Scala
- Fatebenefratelli Hospital, Naples, Italy
| | - C Mandurino
- Santissima Annunziata" Hospital, Taranto, Italy
| | | | - L Poggio
- Ospedale Maggiore Di Lodi, Lodi, Italy
| | - M Scarano
- Madonna del Soccorso" Hospital, San Benedetto del Tronto (AP), Italy
| | | | - F Palma
- Mons. Dimiccoli" Hospital, Barletta, Italy
| | | | - D Porcelli
- San Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - M Racheli
- San Pellegrino Hospital, Castiglione Delle Stiviere (MN), Italy
| | - M Montoy
- Department of Cardiology, Hôpital de La Croix Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Gd Rue de La Croix-Rousse, 69004, Lyon, France
| | - P Charles
- Department of Cardiology, Hôpital de La Croix Rousse Et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Gd Rue de La Croix-Rousse, 69004, Lyon, France
| | - M Campari
- Boston Scientific Italia, Milan, Italy
| | | | - C Lavalle
- Department of Cardiovascular, Respiratory, NephrologicalAnesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
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Kawatani Y, Hori T. Correlation between the electrocardiogram amplitude detected by an implantable cardiac monitor and the implantation depth. Ann Noninvasive Electrocardiol 2024; 29:e13102. [PMID: 38088202 PMCID: PMC10770816 DOI: 10.1111/anec.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/17/2023] [Accepted: 11/28/2023] [Indexed: 12/22/2023] Open
Abstract
INTRODUCTION Implantable cardiac monitors (ICMs) primarily use R-R intervals in subcutaneous electrocardiograms (ECGs) to detect arrhythmias. Therefore, reliable detection of R-wave amplitude by an ICM is vital. Since ICMs detect subcutaneous ECGs, the impact of the implantation depth should be assessed. METHODS AND RESULTS This study investigated the influence of ICM depth on R-wave (ICM-R) amplitude on an ECG generated by an ICM (JOT Dx; Abbott). Overall, 58 patients who underwent ICM implantation at Kamagaya General Hospital from May 2022 to April 2023 were retrospectively reviewed. The depth-position was measured using ultrasound imaging after implantation. The depth of the ICM did not show any correlation with ICM-R amplitude (r = -.0141, p = .294). However, the distance between the ICM and the heart surface showed a significant correlation with ICM-R amplitude (r = -.581, p < .001). Body weight (r = -.0283, p = .033) and body mass index (r = -.0342, p = .009) were associated with ICM-R amplitude. S wave in the V1 -lead was also associated with ICM-R amplitude (r = .481, p < .001). After multivariate analysis, the distance between the ICM and heart surface and the S wave in V1 were independent determinants for the ICM-R amplitude. CONCLUSION The ICM-R amplitude may be higher with the ICM implanted deeper.
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Affiliation(s)
- Yohei Kawatani
- Cardiovascular SurgeryKamagaya General HospitalKamagaha‐ShiJapan
| | - Takaki Hori
- Cardiovascular SurgeryKamagaya General HospitalKamagaha‐ShiJapan
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Russo V, Covino S, De Pasquale V, Parente E, Comune A, Rago A, Papa AA, Ammendola E, Spadaro Guerra A, Napoli P, Golino P, Nigro G. Remote monitoring of implantable cardiac monitors in patients with unexplained syncope: Predictors of false-positive alert episodes. Pacing Clin Electrophysiol 2023; 46:1500-1508. [PMID: 37885375 DOI: 10.1111/pace.14851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Remote monitoring is recommended for patients with implantable cardiac monitors (ICMs), but compared to other cardiac implantable devices, ICMs are less accurate and transmit a higher number of alerts. OBJECTIVE The aim of this study was to investigate the predictors of false-positive (FP) arrhythmic alerts in patients with unexplained syncope who were implanted with ICM and followed by an automatic remote monitoring system. METHODS We retrospectively evaluated all consecutive patients who received a long-sensing vector ICM for unexplained syncope between January 2019 to September 2021 at our Syncope Unit. The primary endpoint was the incidence of the first FP episode. The secondary endpoints included assessing the incidence of FP episodes for all types of algorhythms and indentifying the reasons for the misdetection of these episodes. RESULTS Among 105 patients (44.8% males, median age 51 years), 51 (48.6%) transmitted at least one FP alert during a median follow-up of 301 days. The presence of pre-ventricular complexes (PVCs) on the resting electrocardiogram was the only clinical characteristic associated with an increased risk of FP alerts (adjusted Hazard ratio [HR] 5.76 [2.66-12.4], p = 0.010). The other significant device-related variables were a low-frequency filter at 0.05 Hz versus the default 0.5 Hz (adjusted HR 3.82 [1.38-10.5], p = 0.010) and the R-wave amplitude (adjusted HR 0.35 [0.13-0.99], p = 0.049). CONCLUSION Patients who have PVCs are at higher risk of inappropriate ICM activations. To reduce the occurrence of FP alerts, it may be beneficial to target a large R-wave amplitude during device insertion and avoid programming a low-frequency filter at 0.05 Hz.
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Affiliation(s)
- Vincenzo Russo
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Simona Covino
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Valentina De Pasquale
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Erika Parente
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Angelo Comune
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Ernesto Ammendola
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | | | - Paola Napoli
- Clinical Research Unit, Biotronik Italia S.p.A., Milan, Italy
| | - Paolo Golino
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
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Pitman BM, Zanker A, Lim M, McLoughney J, Spinelli J, Tarone R, McInnes K, Heath KM, Gieve M, Evans S, Young GD, Roberts-Thomson KC, Wong CX, Sanders P, Lau DH. Factors affecting electrogram sensing in an insertable cardiac monitor: Insights from surface electrocardiogram mapping analysis. Heart Rhythm 2023; 20:1297-1306. [PMID: 37321384 DOI: 10.1016/j.hrthm.2023.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fidelity of electrogram sensing may reduce false alerts from an insertable cardiac monitor (ICM). OBJECTIVE The purpose of this study was to assess the effect of vector length, implant angle, and patient factors on electrogram sensing using surface electrocardiogram (ECG) mapping. METHODS Twelve separate precordial single-lead surface ECGs were acquired from 150 participants at 2 interelectrode distances (75 and 45 mm), at 3 vector angles (vertical, oblique, and horizontal), and in 2 postures (upright and supine). A subset of 50 patients also received a clinically indicated ICM implant in 1:1 ratio (Reveal LINQ [Medtronic, Minneapolis, MN]/BIOMONITOR III [Biotronik, Berlin, Germany]). All ECGs and ICM electrograms were analyzed by blinded investigators using DigitizeIt software (V2.3.3, Braunschweig, Germany). The P-wave visibility threshold was set at > 0.015 mV. Logistic regression was used to identify factors affecting P-wave amplitude. RESULTS A total of 1800 tracings from 150 participants (44.5% [n = 68] female; median age 59 [35-73] years) were assessed. The median P- and R-wave amplitudes were 45% and 53% larger with vector lengths of 75 and 45 mm, respectively (P < .001 for both). The oblique orientation yielded the best P- and R-wave amplitudes, while posture change did not affect P-wave amplitude. Mixed effects modeling found that visible P-waves occur more frequently with a vector length of 75 mm than with 45 mm (86% vs 75%, respectively; P < .0001). A longer vector length improved both P-wave amplitude and visibility in all body mass index categories. There was a moderate correlation of P- and R-wave amplitudes from the ICM electrograms to those from surface ECG recordings (intraclass correlation coefficient 0.74 and 0.80, respectively). CONCLUSION Longer vector length and oblique implant angle yielded the best electrogram sensing and are relevant considerations for ICM implantation procedures.
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Affiliation(s)
- Bradley M Pitman
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Zanker
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew Lim
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua McLoughney
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jade Spinelli
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rachel Tarone
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kristie McInnes
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kyle M Heath
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mahsa Gieve
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shaun Evans
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Christopher X Wong
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia.
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Bisignani G, De Bonis S, Pierre B, Lau DH, Hofer D, Sanfins VM, Hain A, Cabanas P, Martens E, Berruezo A, Eschalier R, Milliez P, Lüsebrink U, Mansourati J, Papaioannou G, Giacopelli D, Gargaro A, Ploux S. Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety. Front Cardiovasc Med 2023; 10:1148052. [PMID: 37025684 PMCID: PMC10071510 DOI: 10.3389/fcvm.2023.1148052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Background Fat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m2] and normal-weight controls (BMI <30 kg/m2) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM. Materials and methods Patients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61-90 and days 1-90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls. Results The average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P < 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups. Conclusion Although increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was >0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220.
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Affiliation(s)
- Giovanni Bisignani
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
- Correspondence: Giovanni Bisignani
| | - Silvana De Bonis
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
| | | | - Dennis H. Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Daniel Hofer
- Department of Cardiology, UniversitätsspitalZürich, Zurich, Switzerland
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira—Guimarães, Guimarães, Portugal
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Department of Cardiology, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Antonio Berruezo
- Department of Cardiology, Centro Médico Teknon, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont Ferrand, France
| | - Paul Milliez
- Department of Cardiology, Le Centre Hospitalier Universitaire de Caen CHRU Caen, Caen, France
| | - Ulrich Lüsebrink
- Department of Cardiology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Germany
| | | | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Milano, Italy
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
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Implantable Loop Recorder with Long Sensing Vector: Safety, Acceptability, and Sensing Performance in Pediatric Patients. Pediatr Cardiol 2022; 44:1068-1075. [PMID: 36576525 PMCID: PMC9795155 DOI: 10.1007/s00246-022-03082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
Implantable loop recorders (ILRs) are effective tools for detecting arrhythmias by long-term continuous heart rhythm monitoring. Benefits have been demonstrated even in pediatric patients. ILR with a long sensing vector has recently been designed to improve signal quality in terms of P wave visibility and R wave amplitude. However, there are no data on its use in pediatric patients. We considered a series of pediatric patients implanted with a long sensing vector ILR. Sensing performance, including R wave amplitude and P wave visibility, device-related complications, and diagnostic yield were collected. During follow-up, each patient guided by his/her parents/guardians was also asked to complete a brief questionnaire to assess patient acceptability of the device. Twenty-five consecutive pediatric patients (mean age 11.3 ± 3.5 years, 72% male) were enrolled. The insertion success rate was 100% on the first attempt with no complications. The median amplitude of the R wave was 1.15 mV (interquartile range, 1.01-1.42) with no significant differences between patients aged ≤ or > 10 years (p = 0.726) and between female and male (p = 0.483). P wave was classified as 'always visible' in 24/25 patients (96%). ILR was generally well accepted and tolerated by all involved patients. During a median follow-up of 297 days (117-317), we achieved in 5 patients a correlation between symptoms and rhythm disorders (20%) and ruled out significant arrhythmias in 6 symptomatic children (24%). Long sensing vector ILR showed to be well accepted, with good signal quality and an excellent safety profile even in pediatric patients.
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Swale M, Paul V, Delacroix S, Young G, McSpadden L, Ryu K, Di Fiore D, Santos M, Tan I, Conradie A, Duong M, Schwarz N, Worthley S, Pavia S. Changes in R-wave amplitude at implantation are associated with gender and orientation of insertable cardiac monitor: observations from the confirm Rx™ body posture and physical activity study. BMC Cardiovasc Disord 2022; 22:439. [PMID: 36209063 PMCID: PMC9548115 DOI: 10.1186/s12872-022-02752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are small subcutaneously implanted devices that detect changes in R-wave amplitudes (RWAs), effective in arrhythmia-monitoring. Although ICMs have proven to be immensely successful, electrical artefacts are frequent and can lead to misdiagnosis. Thus, there is a growing need to sustain and increase efficacy in detection rates by gaining insight into various patient-specific factors such as body postures and activities. Methods RWAs were measured in 15 separate postures, including supine, lying on the right-side (RS) or left-side (LS) and sitting, and two separate ICM orientations, immediately after implantation of Confirm Rx™ ICM in 99 patients. Results The patients (53 females and 46 males, mean ages 66.62 ± 14.7 and 66.40 ± 12.25 years, respectively) had attenuated RWAs in RS, LS and sitting by ~ 26.4%, ~ 27.8% and ~ 21.2% respectively, compared to supine. Gender-based analysis indicated RWAs in RS (0.32 mV (0.09–1.03 mV), p < 0.0001) and LS (0.37 mV (0.11–1.03 mV), p = 0.004) to be significantly attenuated compared to supine (0.52 mV (0.20–1.03 mV) for female participants. Similar attenuation was not evident for male participants. Further, parasternally oriented ICMs (n = 44), attenuated RWAs in RS (0.37 mV(0.09–1.03 mV), p = 0.05) and LS (0.34 mV (0.11–1.03 mV), p = 0.02) compared to supine (0.48 mV (0.09–1.03 mV). Similar differences were not observed in participants with ICMs in the 45°-relative-to-sternum (n = 46) orientation. When assessing the combined effect of gender and ICM orientation, female participants demonstrated plausible attenuation in RWAs for RS and LS postures compared to supine, an effect not observed in male participants. Conclusion This is the first known study depicting the effects on RWA due to body postures and activities immediately post-implantation with an overt impact by gender and orientation of ICM. Future work assessing the cause of gender-based differences in RWAs may be critical. Trial registration: Clinical Trials, NCT03803969. Registered 15 January 2019 – Retrospectively registered, https://clinicaltrials.gov/NCT03803969
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Affiliation(s)
- Matthew Swale
- The Valley Private Hospital, Mulgrave, VIC, Australia
| | - Vincent Paul
- St. John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Sinny Delacroix
- Abbott, Sylmar, CA, USA. .,GenesisCare, Leabrook, 284 Kensington Road, Leabrook, SA, Australia.
| | - Glenn Young
- St. Andrew's Hospital, Adelaide, SA, Australia
| | | | | | - David Di Fiore
- Friendly Society Private Hospital, Bundaberg, QLD, Australia
| | | | | | - Andre Conradie
- Friendly Society Private Hospital, Bundaberg, QLD, Australia
| | - MyNgan Duong
- GenesisCare, Leabrook, 284 Kensington Road, Leabrook, SA, Australia
| | - Nisha Schwarz
- GenesisCare, Leabrook, 284 Kensington Road, Leabrook, SA, Australia
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Guarracini F, Testolina M, Giacopelli D, Martin M, Triglione F, Coser A, Quintarelli S, Bonmassari R, Marini M. Programming Optimization in Implantable Cardiac Monitors to Reduce False-Positive Arrhythmia Alerts: A Call for Research. Diagnostics (Basel) 2022; 12:diagnostics12040994. [PMID: 35454042 PMCID: PMC9025722 DOI: 10.3390/diagnostics12040994] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 01/25/2023] Open
Abstract
No studies have investigated whether optimizing implantable cardiac monitors (ICM) programming can reduce false-positive (FP) alerts. We identified patients implanted with an ICM (BIOMONITOR III) who had more than 10 FP alerts in a 1-month retrospective period. Uniform adjustments of settings were performed based on the mechanism of FP triggers and assessed at 1 month. Eight patients (mean age 57.5 ± 23.2 years; 37% female) were enrolled. In 4 patients, FPs were caused by undersensing of low-amplitude premature ventricular contractions (PVCs). No further false bradycardia was observed with a more aggressive decay of the dynamic sensing threshold. Furthermore, false atrial fibrillation (AF) alerts decreased in 2 of 3 patients. Two patients had undersensing of R waves after high-amplitude PVCs; false bradycardia episodes disappeared or were significantly reduced by limiting the initial value of the sensing threshold. Finally, the presence of atrial ectopic activity or irregular sinus rhythm generated false alerts of AF in 2 patients that were reduced by increasing the R-R variability limit and the confirmation time. In conclusion, adjustments to nominal settings can reduce the number of FP episodes in ICM patients. More research is needed to provide practical recommendations and assess the value of extended ICM programmability.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (M.M.); (A.C.); (S.Q.); (R.B.); (M.M.)
- Correspondence: ; Tel.: +39-33-9642-4477
| | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Vimodrone, 20090 Milano, Italy; (D.G.); (F.T.)
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, 35128 Padova, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (M.M.); (A.C.); (S.Q.); (R.B.); (M.M.)
| | - Francesco Triglione
- Clinical Unit, Biotronik Italia, Vimodrone, 20090 Milano, Italy; (D.G.); (F.T.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (M.M.); (A.C.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (M.M.); (A.C.); (S.Q.); (R.B.); (M.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (M.M.); (A.C.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (M.M.); (A.C.); (S.Q.); (R.B.); (M.M.)
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Recording of Brugada electrocardiogram pattern by an implantable cardiac monitor. J Electrocardiol 2022; 72:95-97. [DOI: 10.1016/j.jelectrocard.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/03/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022]
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