Pitman, B.M.Kadhim, K.Tarone, R.Jones, E.Linz, D.Lim, M.Heath, K.M.Scanlan, N.Roberts-Thomson, K.C.Young, G.D.Wong, C.X.Sanders, P.Mariani, J.A.Lau, D.H.2022-07-112022-07-112022Journal of Electrocardiology, 2022; 73:42-480022-07361532-8430https://hdl.handle.net/2440/135772Background: Little data exists on electrogram sensing in current generation of miniaturized insertable cardiac monitors (ICMs). Objective: To compare the sensing capability of ICM with different vector length: Medtronic Reveal LINQ (~40 mm) vs. Biotronik Biomonitor III (BM-III, ~70 mm). Methods: De-identified remote monitoring transmissions from n = 40 patients with BM-III were compared with n = 80 gender and body mass index (BMI)-matched patients with Reveal LINQ. Digital measurement of P- and R- wave amplitude from calibrated ICM electrograms was undertaken by 3 investigators independently. Further, we evaluated the impact of BMI and gender on P-wave visibility. Results: Patients in both groups were well matched for gender and BMI (53% male, mean BMI 26.7 kg/m2, both p = NS). Median P- and R-wave amplitude were 97% & 56% larger in the BM-III vs. LINQ [0.065 (IQR 0.039–0.10) vs. 0.033 (IQR 0.022–0.050) mV, p < .0001; & 0.78 (IQR 0.52–1.10) vs. 0.50 (IQR 0.41–0.89) mV, p = .012 respectively). The P/R-wave ratio was 36% greater with the BM-III (p < .001). The 25th percentile of P- wave amplitude for all 120 patients was .026 mV. Logistic regression analysis showed BM-III was more likely than LINQ to have P-wave amplitude ≥.026 mV (OR 7.47, 95%CI 1.965–29.42, p = .003), and increasing BMI was negatively associated with P-wave amplitude ≥.026 mV (OR 0.84, 95%CI 0.75–0.95, p = .004). However, gender was not significantly associated with P-wave amplitude ≥.026 mV (p = .37). Conclusion: The longer ICM sensing vector of BM-III yielded larger overall P- and R- wave amplitude than LINQ. Both longer sensing vector and lower BMI were independently associated with greater P-wave visibility.en© 2022 Elsevier Inc. All rights reserved.Insertable cardiac monitor; Loop recorder; Biomonitor; Reveal LINQ; P-waveJournal article10.1016/j.jelectrocard.2022.05.0082022-07-07613699Pitman, B.M. [0000-0001-6610-3473]Kadhim, K. [0000-0002-8928-0402]Linz, D. [0000-0003-4893-0824]Wong, C.X. [0000-0002-1913-6675]Sanders, P. [0000-0003-3803-8429]Lau, D.H. [0000-0001-7753-1318] [0000-0002-1564-439X]