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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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Covino S, Russo V. False-positive alarms in patients with implantable loop recorder followed by remote monitoring: A systematic review. Pacing Clin Electrophysiol 2024; 47:406-416. [PMID: 38341627 DOI: 10.1111/pace.14941] [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: 11/02/2023] [Revised: 12/15/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
Remote Monitoring (RM) has been shown to provide useful information about arrhythmic events in patients with implantable loop recorders (ILRs), however there is few and conflicting data about the false positive (FP) alarms burden and characteristics among ILR recipients. The aim of the present systematic review was to evaluate incidence and characteristics of FP alarms among ILR patients followed by RM. We developed a systematic research in Embase, MEDLINE and PubMed databases and selected all papers focused on false positive ILR transmissions published from June 1, 2013 to June 1, 2023. Case reports, meeting summaries, posters and simple reviews were excluded. Twelve reports were finally selected, including five prospective and seven retrospective studies. Information about population characteristics, device type and setting, overall transmissions and FP alarms and any adopted strategies to reduce them were extracted from an overall population of 3.305 patients. FP alarms were 59.7% of the overall remote transmissions and were found in 1/5 of the analyzed population. FP alarms for atrial fibrillation were the most common cause of false transmissions and were mainly due to premature atrial and ventricular complexes. No clinical predictors of FP alarms were identified, except for nonparasternal ILR implantation site. Since the overload work due to FP alarms might reduce the benefit of remote monitoring of ILR patients, the device optimization is an important step until an help from machine-learning algorithms is available.
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Affiliation(s)
- Simona Covino
- Cardiology Unit, Department of Medical Translational Science, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Science, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
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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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Guarracini F, Maines M, Nappi F, Vitulano G, Marini M, Urraro F, Franculli F, Napoli P, Giacopelli D, Del Greco M, Giammaria M. Daily and automatic remote monitoring of implantable cardiac monitors: A descriptive analysis of transmitted episodes. Int J Cardiol 2023; 389:131199. [PMID: 37481001 DOI: 10.1016/j.ijcard.2023.131199] [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: 05/26/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Remote Monitoring (RM) is recognized for its ability to enhance the clinical management of patients with implantable cardiac monitor (ICM). This study aims to provide a comprehensive description of the arrhythmic episodes transmitted by a daily and automatic RM system from a cohort of ICM patients. METHODS The study retrospectively analyzed daily transmissions from consecutive patients who had been implanted with a long-sensing vector ICM (BIOMONITOR III/IIIm) at four sites. All transmitted arrhythmic recordings were evaluated to determine whether they were true positive episodes or false positives (FP). RESULTS A total of 14,136 episodes were transmitted from 119 patients (74.8% male, median age 62 years old) during a median follow-up of 371 days. The rate of arrhythmic episodes was 14.2 per patient-year (interquartile range: 1.8-126), with 97 patients (81.5%) experiencing at least one ICM activation. Fifty-five percent of episodes were identified as FP, and 67 patients (56.3%) had at least one inappropriate activation. The FP rate was 1.4 per patient-year (0-40). The best per-episode predictive positive values were observed for bradycardia and atrial fibrillation (0.595 and 0.553, respectively). Notably, the implementation of an algorithm designed to minimize false detections significantly reduced the prevalence of atrial fibrillation FP episodes (17.6% vs. 43.5%, p = 0.008). CONCLUSION Daily and automatic RM appears to be a reliable tool for the comprehensive remote management of ICM patients. However, the number of arrhythmic episodes requiring review is high, and further improvements are needed to reduce FP and facilitate accurate interpretation of transmissions.
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Affiliation(s)
| | | | - Felice Nappi
- Division of Cardiology, Moscati Hospital, Avellino, Italy
| | - Gennaro Vitulano
- Division of Cardiology, OO.RR. San Giovanni di Dio Ruggi d'Aragona, 84131 Salerno (SA), Italy
| | | | | | - Fabio Franculli
- Division of Cardiology, OO.RR. San Giovanni di Dio Ruggi d'Aragona, 84131 Salerno (SA), Italy
| | - Paola Napoli
- Clinical Unit, Biotronik Italia S.p.a, Cologno Monzese (MI), Italy
| | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia S.p.a, Cologno Monzese (MI), Italy; Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy
| | - Maurizio Del Greco
- Department of Cardiology, Santa Maria del Carmine Hospital, Rovereto, Italy
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