Implantable Loop Recorders—Syncope, Cryptogenic Stroke, Atrial Fibrillation

Mittal, Suneet

doi:10.1016/j.ccep.2021.04.006

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…Third, our study did not consider observational cohort studies which previous study included, because observational cohort studies might have selection bias and heterogeneity, which might affect the reliability and accuracy of the results. Previous meta-analysis found that ICM has shown high sensitivity and specificity for detecting AF [19][20][21][22][23]. The most important question with any intervention in clinical studies is whether it will impact clinically meaningful or 'hard' outcomes.…”

Section: Plos Onementioning

confidence: 99%

Effect of implantable cardiac monitors on preventing stroke: A systematic review and meta-analysis of randomized clinical trials

Xiao

Hao

et al. 2023

PLoS ONE

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Background and aim Implantable cardiac monitors (ICM) can facilitate the detection of asymptomatic atrial fibrillation episodes. We performed a systematic review and meta-analysis to investigate whether ICM can prevent stroke in patients with prior stroke and risk factors for stroke. Methods This study included randomized controlled trials comparing ICM with conventional (non-ICM) external cardiac monitoring in patients with prior stroke and risk factors for stroke. We searched Medline, Embase, and CENTRAL from inception until January 5, 2022, without language restriction. Quantitative pooling of the data was undertaken using a random-effects model. The primary outcome was ischemic stroke at the longest follow-up. Results Four trials comprising 7237 patients were included. ICM was significantly associated with decreased risk of ischemic stroke (RR 0.76; 95% CI, 0.59–0.97; moderate-quality evidence) in patients with prior stroke and risk factors for stroke. ICM was associated with higher detection of atrial fibrillation (RR 4.21, 95% CI 2.26–7.85) and use of oral anticoagulants (RR 2.29, 95% CI 2.07–2.55). Conclusions ICM results in a significantly lower risk of ischemic stroke than conventional (non-ICM) external cardiac monitoring in patients with prior stroke and risk factors for stroke. Due to the clinical heterogeneity of study population and limited related studies, more trials were needed to furtherly explore the topic in patients with prior stroke or high risk of stroke.

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Section: Plos Onementioning

confidence: 99%

Effect of implantable cardiac monitors on preventing stroke: A systematic review and meta-analysis of randomized clinical trials

Xiao

Hao

et al. 2023

PLoS ONE

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“…Insertable cardiac monitors (ICMs) have been increasingly used to help medical professionals diagnose patients who experience unexplained symptoms or have an increased risk of cardiac arrhythmias. [1][2][3] These subcutaneous devices automatically detect and record arrhythmia episodes and patient-activated symptom episodes, and transmit those episodes to remote monitoring data servers for clinician review. As arrhythmia detection algorithms inevitably provide some false positive (FP) episodes, secondary discrimination algorithms have been incorporated.…”

Section: Introductionmentioning

confidence: 99%

Novel algorithms improve arrhythmia detection accuracy in insertable cardiac monitors

Gopinathannair

Shehata

Afzal

et al. 2023

Cardiovasc electrophysiol

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IntroductionInsertable cardiac monitors (ICMs) are commonly used to diagnose cardiac arrhythmias. False detections in the latest ICM systems remain an issue, primarily due to inaccurate R‐wave sensing. New discrimination algorithms were developed and tested to reduce false detections of atrial fibrillation (AF), pause, and tachycardia episodes in ICMs.MethodsStored electrograms (EGMs) of AF, pause, and tachycardia episodes detected by Abbott Confirm Rx™ ICMs were extracted from the Merlin.net™ Patient Care Network, and manually adjudicated to establish independent training and testing datasets. New discrimination algorithms were developed to reject false episodes due to inaccurate R‐wave sensing, P‐wave identification, and R–R interval patterns. The performance of these new algorithms was quantified by false positive reduction (FPR) and true positive maintenance (TPM), relative to the existing algorithms.ResultsThe new AF detection algorithm was trained on 5911 EGMs from 744 devices, resulting in 66.9% FPR and 97.8% TPM. In the testing data set of 1354 EGMs from 119 devices, this algorithm achieved 45.8% FPR and 97.0% TPM. The new pause algorithm was trained on 7178 EGMs from 1490 devices, resulting in 70.9% FPR and 98.7% TPM. In the testing data set of 1442 EGMs from 340 devices, this algorithm achieved 74.4% FPR and 99.3% TPM. The new tachycardia algorithm was trained on 520 EGMs from 204 devices, resulting in 57.0% FPR and 96.6% TPM. In the testing data set of 459 EGMs from 237 devices, this algorithm achieved 57.9% FPR and 96.5% TPM.ConclusionThe new algorithms substantially reduced false AF, pause, and tachycardia episodes while maintaining the majority of true arrhythmia episodes detected by the Abbott ICM algorithms that exist today. Implementing these algorithms in the next‐generation ICM systems may lead to improved detection accuracy, in‐clinic efficiency, and device battery longevity.

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Cardiothoracic Medical Devices – A Pictorial Review

Gayer

2024

Seminars in Ultrasound, CT and MRI

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Implantable Loop Recorders—Syncope, Cryptogenic Stroke, Atrial Fibrillation

Cited by 3 publications

References 26 publications

Effect of implantable cardiac monitors on preventing stroke: A systematic review and meta-analysis of randomized clinical trials

Effect of implantable cardiac monitors on preventing stroke: A systematic review and meta-analysis of randomized clinical trials

Novel algorithms improve arrhythmia detection accuracy in insertable cardiac monitors

Cardiothoracic Medical Devices – A Pictorial Review

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