Performance of a new atrial fibrillation detection algorithm in a miniaturized insertable cardiac monitor: Results from the Reveal LINQ Usability Study

Sanders, Prashanthan; Pürerfellner, Helmut; Pokushalov, Evgeny; Sarkar, Shantanu; Bacco, Marco Di; Maus, Bärbel; Dekker, Lukas

doi:10.1016/j.hrthm.2016.03.005

Cited by 145 publications

(135 citation statements)

References 23 publications

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“…34 The arrhythmic burden can be quantified with a continuous monitoring system, even though ILR data have shown a good correlation with continuous Holter monitoring. 35,36 Finally, the registration of the beginning of an AF episode with event recorders may help to establish the pathogenic mechanism of the arrhythmia. For example, AF episodes that are preceded by frequent atrial ectopic activity most likely have a focal origin.…”

Section: Holter Monitors and Loop Recorders In Patient Follow-upmentioning

confidence: 99%

“…35,36 In the Reveal XT Performance Trial (XPECT), the detection algorithm of the Reveal XT, which is based on R-R interval variation analysis every 2 minutes, identified AF patients with a sensitivity of 96 % and specificity of 85 %. 35 Sensitivity is lower (85 %) when considering the detection of all episodes of AF.…”

Section: Algorithms and Diagnostic Accuracy Of Ilrsmentioning

confidence: 99%

“…35 Sensitivity is lower (85 %) when considering the detection of all episodes of AF. 35,36 Diagnostic accuracy for AF is even higher with the new-generation Reveal LINQ (Medtronic Inc), which also has a P-wave detection algorithm (sensitivity of 97 % and specificity of 97 % for AF patient detection and sensitivity of 97 % for detection of all episodes of AF ≥2 minutes in duration). 36 Both the Reveal XT and the Reveal LINQ data on AF burden are highly correlated with Holter recordings (Pearson coefficient >0.9).…”

Section: Algorithms and Diagnostic Accuracy Of Ilrsmentioning

confidence: 99%

See 2 more Smart Citations

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Galli¹,

Ambrosini²,

Lombardi³

2016

Arrhythmia &Amp; Electrophysiology Review

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Since the 1960s, Holter monitoring has been a cornerstone for diagnosing suspected arrhythmias in patients of all ages. 1 The most common monitoring systems allow the continuous registration of three or more leads for 24-48 hours; newer Holter monitors allow continuous electrocardiogram (ECG) registration for 2 weeks.1 Extending the time of ECG registration will increase the diagnostic yield of Holter monitoring, especially for those rhythm disturbances that are infrequent but recurrent.1,2 This need for a prolonged ECG monitoring has been addressed by event recorders, which can monitor patients for up to 3 years, storing the ECG obtained a few minutes before and after the onset of an arrhythmia in its memory and transmitting data to the cardiac unit. 1,2 When interpreting the results of the ECG, the cardiologist has to determine whether symptoms reported by the patient could be linked to significant disturbances in heart rhythm.2 In other circumstances the detection of atrial or ventricular arrhythmias may alert the cardiologist, even if they occur asymptomatically, thus prompting a specific therapeutic decision such as starting antiarrhythmic or anticoagulant drugs or implanting a pacemaker or a cardioverter defibrillator. Cardiac Monitoring SystemsCardiac rhythm monitoring has an established diagnostic and prognostic role in different circumstances: syncope, palpitations and monitoring of patients with known or suspected episodes of atrial fibrillation (AF), e.g. those with stroke of uncertain aetiology (cryptogenic stroke).1-3 ECG monitoring may also play a role in identifying ventricular tachycardia (VT) in patients with recognised risk of sudden cardiac death. 4 As many devices with different characteristics are available, the choice of the most suitable monitoring system largely depends on the likelihood of detecting a significant correlation between symptoms and ECG findings. Holter MonitorsTraditional ambulatory Holter monitors are simple devices that usually have three leads and continuously register the ECG. They can be short-(24-48 hours) or long-duration (1-2 weeks) devices.1 Two-week Holter monitoring is preferred when diagnosing or excluding AF in cryptogenic stroke, but loop recorders and outpatient telemetry have even higher detection rates. Loop Recorders and Post-event RecordersNewer generation monitors are the so-called event recorders.According to their specific functions they can be divided into two categories: loop recorders, which include external loop recorders (ELRs) and implantable loop recorders (ILRs); and post-event recorders (non-looping recorders). 1 AbstractHolter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holt...

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Section: Holter Monitors and Loop Recorders In Patient Follow-upmentioning

confidence: 99%

Section: Algorithms and Diagnostic Accuracy Of Ilrsmentioning

confidence: 99%

Section: Algorithms and Diagnostic Accuracy Of Ilrsmentioning

confidence: 99%

See 1 more Smart Citation

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Galli¹,

Ambrosini²,

Lombardi³

2016

Arrhythmia &Amp; Electrophysiology Review

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“…7 AF is a significant risk factor for patients, increasing risk of hospitalization, stroke, numerous other comorbidities, and mortality. [7][8][9][10] This results in an increased burden on health care systems. 11 Therefore, accuracy in detection of AF and other arrhythmias is critical for appropriate diagnosis, patient treatment and intervention.…”

Section: Figurementioning

confidence: 99%

Evolution of Implantable Cardiac Monitors: A Comparison of Reveal XT and LINQ Patient Selection, Arrhythmia Detection, and Clinical Outcomes

Sethi

Buescher

Garberich

et al. 2017

Journal of the Minneapolis Heart Institute Foundation

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Implantable cardiac monitors (ICMs) are useful for long-term arrhythmia monitoring in patients with unexplained symptoms. Temporal trends in the use of ICMs in routine clinical practice, along with the clinical indications for use, arrhythmia detection accuracy, and association with clinical outcomes have not been described. We identified all patients who underwent ICM implantation at the Minneapolis Heart Institutet between January 1, 2011, and February 26, 2016, using diagnosis codes for device implantation. From 2011 to 2016, a total of 603 patients with ICM devices were identified and 570 patients were analyzed including 139 Medtronic Reveal XT between 2011 and 2014, and 431 Reveal LINQ between 2014 and 2016. The 3-fold increase in ICM implants was primarily tied to the rise of LINQ monitoring for cryptogenic stroke patients (36% for LINQ vs. 5% for XT; P , 0.001). LINQ patients had fewer complications than XT patients (2.3% vs. 7.9%; P , 0.001). Atrial fibrillation detection accuracy was similar between the devices. Of patients with ICM implants, 30% had at least 1 intervention. The intervention rate was similar between the 2 models (P ¼ 0.40) as was the time to intervention (P ¼ 0.81). Since the release of the LINQ device, there has been an increase in the use of ICM implants among patients with cryptogenic stroke. LINQ ICM monitors have fewer complications post-implant. Only 5.6% of all syncope and cryptogenic stroke patients had a diagnosis within 1 month of implant. Despite potential improvements in arrhythmia detection accuracy, clinic work-flow is influenced by a higher volume of patient activated events that require interpretation.

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“…Newer generation leadless devices have an AF detection algorithm which can filter P waves in order to reduce false positives by 46%, thereby raising both specificity and sensitivity to around 97%. (24) In devices with atrial sensing capability, such as dual-chamber permanent pacemakers, detection of an atrial high rate episode (AHRE) is often used as a surrogate for atrial tachyarrhythmia and AF. Modern devices may automatically identify and store these events as atrial flutter or fibrillation depending on whether or not the rhythm is regular or irregular, respectively.…”

Section: Interpretation Of Device-detected Atrial Tachyarrhythmiasmentioning

confidence: 99%

Approach to device-detected subclinical atrial fibrillation

Zyl

McLeod²,

Gersh³

2017

SAHJ

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INTRODUCTIONCardiac implantable electronic devices (CIEDs) are becoming more and more common due to an aging global population and expanded criteria for implantation. During 2009, over 1.3 million new or replaced implantable cardiac devices were implanted worldwide, with around a quarter of these occurring in the United States (US) alone.(1,2) South Africa has experienced substantial growth with an almost 25% rise in CIEDs implanted between 2005 and 2009, as opposed to only 8% in the US.(1) In addition, there is a greater availability of external surface monitoring and implantable loop recorders (ILR). Out of this vast increase in continuous arrhythmia monitoring arises the challenge of how to approach the abundance of data that identifies subclinical arrhythmia, and germane to this discussion, atrial fibrillation (AF).As the most pervasive sustained arrhythmia encountered in clinical practice, AF has risen in age-adjusted incidence over the last half century -a trend which may be plateauing over the last decade.(3,4) After age 40 the lifetime risk of developing AF is almost 1 in 4.(2) As many as 40% of patients are entirely asymptomatic -also termed subclinical AF -and the arrhythmia may only come to the attention of the patient and provider as an incidental finding.(5) Population screening of those over 65 years of age would detect subclinical AF in an estimated 1.4% of patients -of whom, more than two thirds would be at high risk for stroke based on clinical risk prediction models.(6) AF shares many risk factors -including age, male gender, heart failure and coronary disease -with indications for a permanent pacemaker or implantable cardioverter defibrillator (ICD) and, as such, the detection of clinically silent paroxysms of AF by device interrogation is not uncommon. In patients with CIEDs placed for unrelated indications, without a prior history of permanent AF, 43% had 5 minutes or more of AF detected over 2 years of follow-up in a pooled analysis of 5 large prospective trials (n=10 016).(7) Therefore, adoption of a strategy for dealing with device-detected subclinical AF is vital for clinicians.In the midst of several studies which demonstrate the con-

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Performance of a new atrial fibrillation detection algorithm in a miniaturized insertable cardiac monitor: Results from the Reveal LINQ Usability Study

Abstract: The new AF detection algorithm in the Reveal LINQ ICM accurately detects the presence or absence of AF. Additionally, it showed high sensitivity in detecting AF duration in patients with a history of intermittent and symptomatic AF.

Cited by 145 publications

References 23 publications

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Evolution of Implantable Cardiac Monitors: A Comparison of Reveal XT and LINQ Patient Selection, Arrhythmia Detection, and Clinical Outcomes

Approach to device-detected subclinical atrial fibrillation

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