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Bisignani G, Cheung JW, Rordorf R, Kutyifa V, Hofer D, Berti D, Di Biase L, Martens E, Russo V, Vitillo P, Zoutendijk M, Deneke T, Köhler I, Schrader J, Upadhyay G. Implantable cardiac monitors: artificial intelligence and signal processing reduce remote ECG review workload and preserve arrhythmia detection sensitivity. Front Cardiovasc Med 2024; 11:1343424. [PMID: 38322767 PMCID: PMC10844377 DOI: 10.3389/fcvm.2024.1343424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Implantable 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. Methods Patients 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. Results Of 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. Conclusion SmartECG 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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Affiliation(s)
| | - Jim W. Cheung
- Division of Cardiology, Weill Cornell Medicine, New York, NY, United States
| | - Roberto Rordorf
- Department of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, United States
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Dana Berti
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Luigi Di Biase
- Arrhythmia Services, Albert Einstein College of Medicine at Montefiore Health System, New York, NY, United States
| | - Eimo Martens
- Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Vincenzo Russo
- Department of Cardiology, University Vanvitelli, Monaldi Hospital, Napoli, Italy
| | - Paolo Vitillo
- Department of Cardiology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità San Giuseppe Moscati, Avellino, Italy
| | - Marlies Zoutendijk
- Department of Cardiology, Admiraal de Ruyter Ziekenhuis, Goes, Netherlands
| | - Thomas Deneke
- Department of Cardiology, Rhön Clinic Campus Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | | | | | - Gaurav Upadhyay
- Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL, United States
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