Are implantable cardiac monitors reliable tools for cardiac arrhythmias detection? An intra-patient comparison with permanent pacemakers

Bisignani, Antonio; Bonis, Silvana De; Mancuso, Luigi; Ceravolo, Gianluca; Giacopelli, Daniele; Pelargonio, Gemma; Lanza, Gaetano Antonio; Crea, Filippo; Bisignani, Giovanni

doi:10.1016/j.jelectrocard.2020.02.014

Cited by 13 publications

(31 citation statements)

References 16 publications

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“…Among them, false high ventricular rate detections due to noise oversensing can be frequent and this is not unexpected since sECG is less protected by myopotential or external interference 6 . Inappropriate recordings due to oversensing of other physiological signals appear to be less frequent in ICM recipients.…”

Section: Discussionmentioning

confidence: 99%

How to solve T‐wave oversensing in an implantable cardiac monitor with a long sensing vector?

Carretta

Troccoli

Guerra

et al. 2020

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 99%

How to solve T‐wave oversensing in an implantable cardiac monitor with a long sensing vector?

Carretta

Troccoli

Guerra

et al. 2020

Pacing Clinical Electrophis

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“…The performance of ICMs in AF detection has been evaluated in comparison with 48-h Holter monitoring in a number of studies, which have reported high sensitivity (96-100%) and high negative predictive values (98% for the absence of AF in the XPECT trial [29]). But specificity has been less constantly impressive, ranging from 67 to 86% [7,18,29]. The rate of false positives for AF detection can be as high as 42% [7].…”

Section: Insertable Cardiac Monitorsmentioning

confidence: 99%

“…But specificity has been less constantly impressive, ranging from 67 to 86% [7,18,29]. The rate of false positives for AF detection can be as high as 42% [7]. A randomised comparison in 2016 reported significantly higher rates of correct AF identification with pacemakers than with ICM (97% vs 55%) as well as significantly greater sensitivity and specificity and PPV [50].…”

Section: Insertable Cardiac Monitorsmentioning

confidence: 99%

“…For risk assessment purposes, these differences may not be as important as the numbers imply. ICMs appear to perform similarly to pacemakers in assessing the total AF burden, with false-positive and false-negative episodes to some extent cancelling each other out in the total assessment [ 7 , 50 ]. For other arrhythmias, Maines et al.…”

Section: Insertable Cardiac Monitorsmentioning

confidence: 99%

“…The false positive arrhythmia alerts which drive the inaccurate diagnostic performance of ICM are mostly related to inadequate R‑wave sensing. As the ICM electrodes are positioned at some distance from the cardiac muscle, there is greater scope for interference and artefacts [ 6 , 7 , 47 ]. Typically, an R‑wave sensing value of at least 0.3 mV is targeted [ 21 ].…”

Section: Insertable Cardiac Monitorsmentioning

confidence: 99%

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Over- and undersensing—pitfalls of arrhythmia detection with implantable devices and wearables

Sperzel

Hamm

Hain

2020

Herzschr Elektrophys

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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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Are implantable cardiac monitors reliable tools for cardiac arrhythmias detection? An intra-patient comparison with permanent pacemakers

Cited by 13 publications

References 16 publications

How to solve T‐wave oversensing in an implantable cardiac monitor with a long sensing vector?

How to solve T‐wave oversensing in an implantable cardiac monitor with a long sensing vector?

Over- and undersensing—pitfalls of arrhythmia detection with implantable devices and wearables

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

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