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

Autor:	Pitman BM; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia., Zanker A; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Lim M; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., McLoughney J; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia., Spinelli J; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Tarone R; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia., McInnes K; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Heath KM; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia., Gieve M; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Evans S; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Young GD; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Roberts-Thomson KC; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Wong CX; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia., Sanders P; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia., Lau DH; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia. Electronic address: dennis.h.lau@adelaide.edu.au.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2023 Sep; Vol. 20 (9), pp. 1297-1306. Date of Electronic Publication: 2023 Jun 13.
DOI:	10.1016/j.hrthm.2023.05.034
Abstrakt:	Background: Fidelity of electrogram sensing may reduce false alerts from an insertable cardiac monitor (ICM). Objective: The purpose of this study was to assess the effect of vector length, implant angle, and patient factors on electrogram sensing using surface electrocardiogram (ECG) mapping. Methods: Twelve separate precordial single-lead surface ECGs were acquired from 150 participants at 2 interelectrode distances (75 and 45 mm), at 3 vector angles (vertical, oblique, and horizontal), and in 2 postures (upright and supine). A subset of 50 patients also received a clinically indicated ICM implant in 1:1 ratio (Reveal LINQ [Medtronic, Minneapolis, MN]/BIOMONITOR III [Biotronik, Berlin, Germany]). All ECGs and ICM electrograms were analyzed by blinded investigators using DigitizeIt software (V2.3.3, Braunschweig, Germany). The P-wave visibility threshold was set at > 0.015 mV. Logistic regression was used to identify factors affecting P-wave amplitude. Results: A total of 1800 tracings from 150 participants (44.5% [n = 68] female; median age 59 [35-73] years) were assessed. The median P- and R-wave amplitudes were 45% and 53% larger with vector lengths of 75 and 45 mm, respectively (P < .001 for both). The oblique orientation yielded the best P- and R-wave amplitudes, while posture change did not affect P-wave amplitude. Mixed effects modeling found that visible P-waves occur more frequently with a vector length of 75 mm than with 45 mm (86% vs 75%, respectively; P < .0001). A longer vector length improved both P-wave amplitude and visibility in all body mass index categories. There was a moderate correlation of P- and R-wave amplitudes from the ICM electrograms to those from surface ECG recordings (intraclass correlation coefficient 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 implantation procedures. (Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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