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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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Matsui Y, Mori F, Okano H, Inutsuka K, Takahashi M, Kikuchi K, Kikuchi H, Serikawa N, Sakai M, Maeda R, Tsukamoto K, Saito T. A case report of undetected cardiac arrest in a patient with an insertable cardiac monitor. J Cardiol Cases 2024; 29:89-92. [PMID: 38362579 PMCID: PMC10865137 DOI: 10.1016/j.jccase.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 02/17/2024] Open
Abstract
Insertable cardiac monitors (ICMs) are small electrocardiographs implanted subcutaneously to automatically record electrocardiograms when arrhythmia is detected in patients with syncope. If the ICM misses a significant arrhythmia, it may delay the diagnosis of arrhythmogenic syncope and put the patient at risk. Herein, we describe a case of undetected cardiac arrest in a patient with ICM. An 87-year-old man with syncope was admitted to the hospital. After 8 days of monitoring, the cause could not be determined, and an ICM was implanted. Nine hours after implantation, the patient experienced cardiopulmonary arrest. Despite a body surface electrocardiogram showing ventricular flatline and fibrillation, the ICM failed to record. The cause of failure to record was considered to be the fluctuation in the R-wave amplitude of the ICM and noise oversensing. In conclusion, albeit infrequently, ICMs might overlook life-threatening arrhythmias. Even in cases where the ICM fails to detect an arrhythmia matching the symptoms, it may not be feasible to entirely rule out the presence of arrhythmias. Learning objective Insertable cardiac monitors (ICMs) are used to diagnose arrhythmogenic syncope. However, extremely infrequently, ICM may fail to record life-threatening arrhythmias. Failure to capture arrhythmias can happen due to an unfortunate combination of factors such as a low amplitude of the recorded R wave and noise. Even in cases where the ICM does not detect an arrhythmia that matches the symptoms, it may not be feasible to completely exclude the presence of arrhythmias.
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Affiliation(s)
- Yuko Matsui
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Fumiaki Mori
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Hiromu Okano
- International University of Health and Welfare Graduate School of Public Health, Minato City, Tokyo, Japan
| | - Kei Inutsuka
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Mirai Takahashi
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Kensuke Kikuchi
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Haruka Kikuchi
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Naoki Serikawa
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Masayuki Sakai
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Ryozo Maeda
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Kei Tsukamoto
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
| | - Takashi Saito
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama-shi, Kanagawa, Japan
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Maines M, Degiampietro M, Tomasi G, Poian L, Cont N, Peruzza F, Moggio P, Triglione F, Giacopelli D, Del Greco M. Strategic reprogramming of implantable cardiac monitors reduces the false-positive remote alert burden in a nurse-led service. Eur J Cardiovasc Nurs 2023; 22:773-779. [PMID: 36346102 DOI: 10.1093/eurjcn/zvac103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/18/2023]
Abstract
AIMS Implantable cardiac monitors (ICMs) can generate false-positive (FP) alerts. Although these devices have an extended programmability, there are no recommendations on their optimization to reduce not-relevant activations.We tested a strategic programming optimization guide based on the type of FP and investigated the safety and feasibility of the nurse-led insertion of ICMs with a long-sensing vector. METHODS AND RESULTS Consecutive patients implanted by trained nurses with long-sensing vector ICM were enrolled in a 1-month observational stage (Phase A). Patients who had ≥10 FP episodes underwent ICM reprogramming based on the predefined guide and were followed for an additional month (Phase B). A total of 78 patients had successful ICM insertion by nurses with a mean R wave amplitude of 0.96 ± 0.43 mV and an 86% P wave visibility. Only one patient reported a significant device-related issue, and nurse-delivered ICM was generally well accepted by the patients. During Phase A, 11 patients (14%) generated most of FP (3,627/3,849; 94%) and underwent ICM reprogramming. In the following month (Phase B), five patients (45%) were free from FP and six (55%) transmitted 57 FP alerts (98% reduction compared with Phase A). The median number of FP per patient was significantly reduced after reprogramming [195 (interquartile range, 50-311) vs. one (0-10), P = 0.0002]. CONCLUSION A strategic reprogramming of ICM in those patients with a high FP alert burden reduces the volume of erroneous activations with potential benefits for the remote monitoring service. No concerns were raised regarding nurse-led insertion of ICMs with a long-sensing vector.
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Affiliation(s)
| | | | - Giancarlo Tomasi
- Cardiology Department, Ospedale di Rovereto, 38068 Rovereto, TN, Italy
| | - Luisa Poian
- Cardiology Department, Ospedale di Rovereto, 38068 Rovereto, TN, Italy
| | - Natascia Cont
- Cardiology Department, Ospedale di Rovereto, 38068 Rovereto, TN, Italy
| | - Francesco Peruzza
- Cardiology Department, Ospedale di Rovereto, 38068 Rovereto, TN, Italy
| | - Paolo Moggio
- Cardiology Department, Ospedale di Rovereto, 38068 Rovereto, TN, Italy
| | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Via Volta 16 20093 Cologno Monzese, Italy
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, 35128 Padova, Italy
| | - Maurizio Del Greco
- Clinical Unit, Biotronik Italia, Via Volta 16 20093 Cologno Monzese, 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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Bjerregaard CL, Skaarup KG, Lassen MCH, Biering-Sørensen T, Olsen FJ. Strain Imaging and Ventricular Arrhythmia. Diagnostics (Basel) 2023; 13:diagnostics13101778. [PMID: 37238262 DOI: 10.3390/diagnostics13101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Ventricular arrhythmia is one of the main causes of sudden cardiac death. Hence, identifying patients at risk of ventricular arrhythmias and sudden cardiac death is important but can be challenging. The indication for an implantable cardioverter defibrillator as a primary preventive strategy relies on the left ventricular ejection fraction as a measure of systolic function. However, ejection fraction is flawed by technical constraints and is an indirect measure of systolic function. There has, therefore, been an incentive to identify other markers to optimize the risk prediction of malignant arrhythmias to select proper candidates who could benefit from an implantable cardioverter defibrillator. Speckle-tracking echocardiography allows for a detailed assessment of cardiac mechanics, and strain imaging has repeatedly been shown to be a sensitive technique to identify systolic dysfunction unrecognized by ejection fraction. Several strain measures, including global longitudinal strain, regional strain, and mechanical dispersion, have consequently been proposed as potential markers of ventricular arrhythmias. In this review, we will provide an overview of the potential use of different strain measures in the context of ventricular arrhythmias.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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