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Diagnostic accuracy of R-wave detection by insertable cardiac monitors.
Pacing and Clinical Electrophysiology ( IF 1.7 ) Pub Date : 2020-05-02 , DOI: 10.1111/pace.13912
Margot De Coster 1 , Anthony Demolder 1 , Veerle De Meyer 1 , Filiep Vandenbulcke 1 , Frederic Van Heuverswyn 1 , Jan De Pooter 1
Affiliation  

BACKGROUND Insertable cardiac monitors (ICM) allow prolonged rhythm monitoring, but the diagnostic performance can be hampered by false positive arrhythmia alerts related to inadequate R-wave sensing. This study assesses the prevalence and predictors of inadequate R-wave sensing (both over- and undersensing) among different ICM types. METHODS Patients implanted with an ICM at Ghent University Hospital between January 2017 and August 2018 were included. ICM tracings recorded at interrogation or transmitted by remote monitoring were reviewed for inadequate R-wave sensing leading to false arrhythmia alerts. Patient and implant characteristics were retrieved from the medical records and implant reports. RESULTS The study screened 135 patients (age 59 ± 19 years, 44% female) implanted with different ICM types: Reveal LINQ™ and XT (Medtronic): n = 92 (68%), Confirm and Confirm Rx (Abbott): n = 35 (26%), and BioMonitor 2 (Biotronik): n = 8 (6%). ICM tracings were analyzed in 112 patients (83%). False arrhythmia alerts occurred in 22 (20%) patients, most frequently related to undersensing (77%). False diagnosis of bradycardia or pause was documented in 64%, false high ventricular rates in 14%, and false atrial fibrillation alerts in 22%. Occurrence of R-wave changes was not related to patient characteristics or implant R-wave sensing. A trend toward higher number of inadequate R-wave sensing seems to occur with nonparasternal implant sites (P = .074). CONCLUSIONS False arrhythmia alerts due to inadequate R-wave sensing occurred in 20% of ICM patients independent of implant features and patient characteristics.

中文翻译:

可插入式心脏监护仪对R波检测的诊断准确性。

背景技术可插入的心脏监测器(ICM)允许长时间的心律监测,但是由于与R波感测不充分有关的假阳性心律不齐警报会妨碍诊断性能。这项研究评估了不同ICM类型之间R波感应不足(过度感应和感应不足)的患病率和预测因素。方法纳入2017年1月至2018年8月间在根特大学医院植入ICM的患者。审阅了在讯问中记录或通过远程监控传输的ICM示踪,以检查R波感应不足是否导致假性心律失常警报。从医疗记录和植入报告中检索患者和植入物的特征。结果该研究筛选了135例植入不同ICM类型的患者(年龄59±19岁,女性占44%):Reveal LINQ™和XT(Medtronic):n = 92(68%),确认并确认Rx(Abbott):n = 35(26%),BioMonitor 2(Biotronik):n = 8(6%)。对112例患者(83%)的ICM示踪进行了分析。错误的心律失常警报发生在22位(20%)患者中,最常与感觉不足相关(77%)。记录有误诊心动过缓或暂停的发生率为64%,误诊高心室发生率为14%,误诊为房颤提示为22%。R波变化的发生与患者特征或植入物R波感测无关。非胸骨旁植入部位似乎出现了更多的不充分的R波感应趋势(P = .074)。结论在20%的ICM患者中,由R波感应不足引起的假性心律失常警报与植入物特征和患者特征无关。和BioMonitor 2(Biotronik):n = 8(6%)。对112例患者(83%)的ICM示踪进行了分析。错误的心律失常警报发生在22名(20%)患者中,最常与感觉不足相关(77%)。记录有误诊心动过缓或暂停的发生率为64%,误诊高心室发生率为14%,误诊为房颤提示为22%。R波变化的发生与患者特征或植入物R波感测无关。非胸骨旁植入部位似乎出现了更多的不充分的R波感应趋势(P = .074)。结论在20%的ICM患者中,由R波感应不足引起的假性心律失常警报与植入物特征和患者特征无关。和BioMonitor 2(Biotronik):n = 8(6%)。对112例患者(83%)的ICM示踪进行了分析。错误的心律失常警报发生在22位(20%)患者中,最常与感觉不足相关(77%)。记录有误诊心动过缓或暂停的发生率为64%,误诊高心室发生率为14%,误诊为房颤提示为22%。R波变化的发生与患者特征或植入物R波感测无关。对于非胸骨旁植入部位,似乎出现了更多的R波感应不足趋势(P = .074)。结论在20%的ICM患者中,由于R波感应不足引起的假性心律失常警报与植入物特征和患者特征无关。最常与知觉不足有关(77%)。记录有误诊心动过缓或暂停的发生率为64%,误诊高心室发生率为14%,误诊为房颤提示为22%。R波变化的发生与患者特征或植入物R波感测无关。对于非胸骨旁植入部位,似乎出现了更多的R波感应不足趋势(P = .074)。结论在20%的ICM患者中,由于R波感应不足引起的假性心律失常警报与植入物特征和患者特征无关。最常与知觉不足有关(77%)。记录有误诊心动过缓或暂停的发生率为64%,误诊高心室发生率为14%,误诊为房颤提示为22%。R波变化的发生与患者特征或植入物R波感测无关。对于非胸骨旁植入部位,似乎出现了更多的R波感应不足趋势(P = .074)。结论在20%的ICM患者中,由R波感应不足引起的假性心律失常警报与植入物特征和患者特征无关。非胸骨旁植入部位似乎出现了更多的不充分的R波感应趋势(P = .074)。结论在20%的ICM患者中,由R波感应不足引起的假性心律失常警报与植入物特征和患者特征无关。对于非胸骨旁植入部位,似乎出现了更多的R波感应不足趋势(P = .074)。结论在20%的ICM患者中,由R波感应不足引起的假性心律失常警报与植入物特征和患者特征无关。
更新日期:2020-05-02
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