Abstract 12648: Improvements In Post-operative Cardiac Surgery Arrhythmia Identification Using The Atriamp Signals

Abstract

Background: Following cardiac surgery, as many as 60% of patients will experience an arrhythmia. These arrhythmias are associated with increased morbidity and occasional mortality. Therefore, rapid and accurate identification is paramount to the improvement of patient outcome. Unfortunately, until now monitoring was limited by lack of timeliness or clarity. Here we evaluate the confidence and accuracy of rhythm diagnosis using the AtriAmp, a UW device that allows continuous arrhythmia monitoring. Methods: An ongoing IRB approved prospective observational study of children less than or equal to 18 years of age admitted to the PICU with atrial pacing wires following congenital heart surgery. The AtriAmp was connected to atrial pacing wires and the atrial ECG (AEG) was displayed along with a surface ECG on GE monitors. Nine different types of arrhythmias were collected over the course of the first five months of the study. A 20-question online survey was given to critical care and cardiology providers. Ten questions displayed signals from only the surface leads, the other ten showed the same arrhythmias with AtriAmp signal also displayed. Answers were evaluated for confidence and accuracy. Results: 40 providers were given the survey with 72% completing at the time of this abstract submission. Paired t-tests and mixed effects modeling were used to assess the data. The overall accuracy of diagnosis increased when using the Atriamp signals along with the surface ECG, but it was not statistically significant (p=0.07). Improvements in accuracy were most notable with atrial ectopic tachycardia (AET), Ventricular tachycardia (VT) and junctional ectopic tachycardia (JET). Provider confidence in diagnosis increased significantly when using the Atriamp signals (48%) compared to using only the surface ECG (62%) to diagnose arrhythmias (p<0.001). Conclusion: Use of the AtriAmp increased provider confidence in the diagnosis of post-operative arrhythmias when compared to the same arrhythmias seen on surface electrograms. Future research among a larger sample of providers is needed to further evaluate the use of AtriAmp in arrythmia diagnosis.