Does optimized daytime/nighttime programming reduce insertable cardiac monitor event burden?

Abstract

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Boston Scientific. Background Insertable Cardiac Monitors (ICM) are widely used for long term cardiac arrhythmia monitoring and diagnosis. ICMs can generate episodes (and associated alerts) that are non-actionable from a clinical standpoint leading to alert fatigue. In particular, non-actionable bradycardia and pause events may occur at nighttime due to reduced sympathetic tone during sleep. We have used stored auto-detected events to better understand optimal programming with nighttime settings to eliminate potentially clinically non-actionable episodes and improve clinic workflow. Objective Evaluate the reduction in clinic episode review burden in bradycardia (brady) and pause episodes with a new daytime/nighttime programming optimization in LUX-Dx ICM. Methods We analyzed data from 2,555 patients implanted with LUX-Dx ICM that included 132,928 detected brady and pause episodes stored remotely. We evaluated optimized settings with separately programmed nocturnal (11p-7a) and nominal daytime (7a-11p) rates and durations as compared to full-time nominal settings (24-hour nominal). Optimized nocturnal programming was set to trigger event storage on a heart rate setting of ≤30 bpm as well as a duration setting of ≥5s for nocturnal brady and pause episodes. The nominal day time and 24-hour settings for brady and pause episodes were HR ≤40bpm and duration ≥3s. The episode burden was analyzed retrospectively using stored episodes comparing optimized versus full-time nominal programming. Results A simulation using the optimized settings showed that 98% and 90% of the nocturnal bradycardia (n = 1909) and pause episodes (n = 1198) had a HR >30bpm, and duration <5s respectively. As a result, the optimized settings for nocturnal episodes reduced 75% and 56% of bradycardia and pause episodes, respectively. (See Figure 1). At a patient level, 63% and 25% of patients had a substantial reduction (>=50%) in brady and pause episodes, respectively. Conclusion The optimized programming settings, which simply adjusts for nocturnal physiology, may substantially improve clinical workflow by reducing potentially clinically non-actionable episodes and associated alerts detected by the LUX-Dx ICM. More clinical correlative studies are needed to understand patient risk.