Can we See what we'll get: Sensed R Wave Amplitude Guided Programming of Implantable Cardiac Monitors

Abstract

Background Injectable loop recorder (ILR) use has increased leading to increased follow-up burdens for many clinics. Programming variations by physician and sites also vary greatly, especially those of the Automatic Detection Events. Event rates tend to be higher in the immediate post-implantation phase due to acute healing at the insertion site. We analyzed one manufacturer (Confirm Rxtm, Abbott Laboratories) to determine if programming standards may help reduce event rates in this acute phase. Objective We compared Daily Auto-Detected Events (DADE) in patients with specified R-Wave amplitude based Programming (RWP) vs. Other Detection Programming (ODP) in the first 30 days post implant. Symptom initiated events were excluded for consistency between groups. Methods Patient DADE's were logged and reported by PaceMate (Sarasota, FL). Groups were divided into RWP (N=12) vs. ODP (N=20). Auto-recorded events were averaged in their respective groups to a create the DADE rate in which groups were compared for the first 30 days after implant. Results N=32 Patients were evaluated (age 63.7 +/-16.7). The mean DADEs in the RWP group was 1.98 +/-2.99 vs. 5.59 +/- 7.63 in the ODP group (P= N/S). In the ODP group, we compared RWP to out of box nominal setting and physician tailored programming showing DADE rates of 8.6+/-9.8 (P=0.038) vs. 3.06 +/-4.29 (P=N/S) respectively. Programming and analysis can be seen in table 1. Conclusion An overall 65% reduction in DADE's was seen with the RWA group vs. the ODP group. The nominal programming demonstrated he highest rate of DADE's.