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Factors affecting electrogram sensing in insertable cardiac monitor: Insights from surface electrocardiogram mapping analysis

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dc.contributor.authorPitman, B.M.
dc.contributor.authorZanker, A.
dc.contributor.authorLim, M.
dc.contributor.authorMcLoughney, J.
dc.contributor.authorSpinelli, J.
dc.contributor.authorTarone, R.
dc.contributor.authorMcInnes, K.
dc.contributor.authorHeath, K.M.
dc.contributor.authorGieve, M.
dc.contributor.authorEvans, S.
dc.contributor.authorYoung, G.D.
dc.contributor.authorRoberts-Thomson, K.C.
dc.contributor.authorWong, C.X.
dc.contributor.authorSanders, P.
dc.contributor.authorLau, D.H.
dc.date.issued2023
dc.descriptionPublished September 2023
dc.description.abstractBackground: Fidelity of electrogram sensing may reduce false alerts from insertable cardiac monitor (ICM). Objective: To assess impact of vector length, implant angle and patient factors on electrogram sensing using surface electrocardiogram (EKG) mapping. Methods: Twelve separate precordial single-lead surface EKGs were acquired from 150 participants at two inter-electrode distance (75mm & 45mm), three vector angles (vertical, oblique, horizontal) and in two postures (upright & supine). A subset of fifty patients also received a clinically indicated ICM implant in 1:1 ratio (Medtronic Reveal LINQ:Biotronik Biomonitor III). All EKG and ICM electrogram were analyzed by blinded investigators using DigitizeIt software. P-wave visibility threshold was set at >0.015mV. Logistic regression was used to identify factors impacting P-wave amplitude. Results: A total of 1,800 tracings from 150 participants [44.5% female, median 59 years old] were assessed. Median P- and R-wave were 45% and 53% larger with vector length of 75 vs. 45mm respectively (both p<0.001). The oblique orientation yielded the best P- and R-wave sensing while posture change did not impact on P-wave amplitude. Mixed effects modeling found that visible P-waves occur more frequently with vector length of 75mm than 45mm (86% vs. 75% respectively, p<.0001). A longer vector length improved both P-wave amplitude and visibility in all BMI categories. There was moderate correlation of P- and R-waves from the ICM electrogram to surface EKG recordings (ICC 0.74 and 0.80, respectively). Conclusion: Longer vector length and oblique implant angle yielded the best electrogram sensing and are relevant considerations for ICM implantations.
dc.description.statementofresponsibilityBradley M. Pitman, Amy Zanker, Matthew Lim, Joshua McLoughney, Jade Spinelli, Rachel Tarone, Kristie McInnes, Kyle M. Heath, Mahsa Gieve, Shaun Evans, Glenn D. Young, Kurt C. Roberts-Thomson, Christopher X. Wong, Prashanthan Sanders, Dennis H. Lau
dc.identifier.citationHeart Rhythm, 2023; 20(9):1297-1306
dc.identifier.doi10.1016/j.hrthm.2023.05.034
dc.identifier.issn1547-5271
dc.identifier.issn1556-3871
dc.identifier.orcidEvans, S. [0000-0001-5067-2743]
dc.identifier.orcidWong, C.X. [0000-0002-1913-6675]
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.orcidLau, D.H. [0000-0001-7753-1318] [0000-0002-1564-439X]
dc.identifier.urihttps://hdl.handle.net/2440/139111
dc.language.isoen
dc.publisherElsevier
dc.relation.grantNHMRC
dc.rights© 2023 Heart Rhythm Society. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.hrthm.2023.05.034
dc.subjectInsertable cardiac monitor; ECG mapping; Electrogram sensing; P-wave visibility; Vector length
dc.titleFactors affecting electrogram sensing in insertable cardiac monitor: Insights from surface electrocardiogram mapping analysis
dc.typeJournal article
pubs.publication-statusPublished

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