Remote Monitoring of Implantable Loop Recorders: False-Positive Alert Episode Burden

Introduction: Management of voluminous data from implantable cardiac devices is resource intensive. False positive events can be especially problematic with implantable loop recorders (ILRs). We sought to describe our early experience with a novel ILR. Hypothesis: Sensitivity adjustment to <=0.10 mV may reduce false positive ILR detection of bradycardia/pauses. Methods: A single center retrospective study was performed in patients with the Abbott Confirm RX ILR. Tachycardia, atrial fibrillation (AF), bradycardia, and pause events were reviewed to determine whether they were true or false positives. Results: The study included 13 patients (age 67 ±15.8 years, 62% men). The reasons for implant included: AF (n=7, 54%), syncope(n=3, 23%), palpitations (n=2, 15%), and stroke (n=1, 8%). The median follow-up duration was 3.1 months (IQR 1.3-4.4 months). There was no change in serial R waves during mean follow-up of 0.58 months (pre 0.62±0.22 mV, post 0.63±0.22 mV, p=0.52). Tachycardia detection occurred in 6 patients (46%), with only 1 patient having a false positive episode. AF detection occurred in 8 patients (62%), with only 2 patients having true AF episodes. Pause/bradycardia episodes were detected in 5 patients (39%), with false positive episodes in 4 patients. There was no difference in R waves at implant among patients with and without false positive bradycardia/pauses episodes (0.66 ±0.27 vs. 0.44 ± 0.28 mV, p=0.21). The max sensitivity was higher among patients with than without false positive bradycardia/pause episodes (0.14 ±0.01, 0.07 ±0.02 mV, p<0.0001). No patients programmed to sensitivity <=0.10 mV had false positive bradycardia/pause episodes. The sensitivity was adjusted to <=0.10 mV in 3 of 4 patients with false positive bradycardia/pause episodes which eliminated future false positive episodes and did not result in false positive tachycardia/AF episodes. The overall mean monthly rate of false positive bradycardia/pause events was reduced from 387 events/month to zero in these patients. Conclusion: Programming the novel ILR to a sensitivity of <=0.10 mV resulted in a marked reduction in false positive bradycardia/pause episodes without an increase in false positive tachycardia/AF episodes.

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0076: Contributions of remote monitoring to the follow-up of implantable loop recorders: a dual center experience

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(15)71681-2 ◽

2015 ◽

Vol 7 (1) ◽

pp. 68

Author(s):

Peggy Jacon ◽

Aurelien Miralles ◽

Alix Martin ◽

Natacha Pellet ◽

Hager Rekik ◽

...

Keyword(s):

Remote Monitoring ◽

Implantable Loop Recorders

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The feasibility of algorithm-based ECG interpretation in remote monitoring – 53,748 recordings from the Dutch HartWacht program

European Heart Journal - Digital Health ◽

10.1093/ehjdh/ztab104.3086 ◽

2021 ◽

Vol 2 (4) ◽

Author(s):

S Blok ◽

B M I Slaats ◽

G A Somsen ◽

I I Tulevski ◽

L Hofstra ◽

...

Keyword(s):

Sinus Rhythm ◽

Remote Monitoring ◽

Predictive Value ◽

False Positive ◽

Healthcare Providers ◽

Great Promise ◽

Positive Outcomes ◽

Perfect Agreement ◽

Funding Sources ◽

Dedicated Team

Abstract Background Symptom driven remote monitoring programs for cardiac arrhythmias hold great promise, but scalability is limited due to high additional workload for healthcare providers. The Dutch HartWacht arrhythmia program consists of a connected single lead ECG device operated remotely by the patient, an algorithm for classification and a dedicated team of specialized nurses and cardiologists for additional remote interpretation. Correct classification as sinus rhythm (SR) by the algorithm would reduce workload of the HartWacht team, as it makes double-checking redundant. Purpose We investigated agreement of the ECG-classification between the algorithm and the HartWacht team and determined feasibility of the algorithm to classify sinus rhythm (SR). Methods We investigated the algorithm accompanying a single lead, handheld ECG-device that is integrated in the Dutch HartWacht program. We retrospectively studied the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the algorithm for classifying SR on home measured 30-second single lead ECGs. We included all recordings that were classified as SR by the algorithm. We used the classification of the HartWacht team as a reference standard. Results Between April 2020 and January 2021, 1,671 patients with (suspected) arrhythmias (female = 982 (59%), mean age = 58 (±15) years, participating in the HartWacht program, recorded 53,748 ECGs, of which the algorithm interpreted 35,388 (66%) as SR, 10,899 (20%) as possible AF and 7,461 (14%) as other. All recordings were also interpreted by the HartWacht team. Compared to the classification by the team, the algorithm showed a sensitivity for SR of 0.953, specificity of 0.985, PPV of 0.996 and NPV of 0.841. A total of 137 (0,3%) ECGs from 50 (2,8%) patients showed false positive outcomes, classifying recordings as SR while the HartWacht team detected arrhythmias. In 42 of those patients, arrhythmias were detected by the algorithm in other recordings within the program. The remaining 8 (0,5%) patients made a total of 14 (<0,1%) recordings with false positive outcomes without having any other recordings with arrhythmias within the HartWacht program. Conclusion For classifying SR in home measured single lead ECGs, the algorithm and the HartWacht team showed a nearly perfect agreement. The recordings without agreement did not lead to relevant individual changes in diagnostic or therapeutic strategy for the patient. Therefore, the algorithm is feasible as standalone classification. With 66% of the recordings within the HartWacht program showing SR, a corresponding workload reduction can be achieved which importantly increases scalability and cost-effectiveness of remote monitoring of arrhythmia patients. Funding Acknowledgement Type of funding sources: None.

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