Abstract
Implantable loop recorders are commonly used to sense arrhythmias. The purpose of this study is to assess the P- and R-wave amplitudes at implantation (I) and follow-up (F) following insertion of the Reveal LINQ™ Insertable Cardiac Monitor (Medtronic, Minneapolis, MN) in an institutional review board-approved, multicenter study performed on pediatric patients younger than 18 years old. Collected data included demographics, presence of congenital heart disease (CHD), P- and R-wave-sensed amplitude at I and F, and the method of implant (i.e. mapping or standard.) P waves were manually measured and R-wave sensing was recorded by the device. A total of 87 patients had a Reveal LINQ™ (Medtronic, Minneapolis, MN) device implanted; the mean patient age was 11.8 years (0.5 years to 18 years) with 48% of patients being female and 19% of patients having CHD; mapping was used in 43% of patients. The Reveal LINQ™ (Medtronic, Minneapolis, MN) experienced no change in average sensed R-wave amplitude at either I or F (1.28 mV vs 1.26 mV, p = NS). There was no difference in sensed R-wave amplitude noted with or without mapping used at I (1.29 mV vs 1.26 mV, p = NS) or F (1.48 mV vs 1.18 mV, p = NS). Additionally, no difference could be found in R-wave sensing of patients with CHD or without CHD at I (1.26 mV vs 1.4 mV, p = NS) or F (1.32 mV vs 1.32 mV, p = NS). R-wave sensing trended towards being inversely proportional to patient body surface area (BSA) (p = NS). P waves were detected on 48% of tracings in all patients at I and/or F, irrespective of whether the Reveal LINQ™ (Medtronic, Minneapolis, MN) device was placed with mapping. The R wave was (0.37–3.5 mV) at I and (0.3–3 mV) (p = NS) at F when P waves were detected. From these results, it can be said that the Reveal LINQ™ Insertable Cardiac Monitor (Medtronic, Minneapolis, MN) has an excellent ability to sense R-wave amplitude in pediatric patients. No significant difference in the sensing ability of the device could be identified with respect to the presence of CHD, use of mapping or BSA. P waves tended to be identified when there was a higher baseline R-wave amplitude.
Highlights
An implantable loop recorder (ILR) is an ambulatory device used for the detection of arrhythmias over a prolonged period of time.[1]
The average sensed R-wave amplitude recorded by the Reveal LINQt (Medtronic, Minneapolis, MN) device at I was 1.28 mV (0.2–3.5 mV), with no decrease noted at F 1.26 mV (0.2–3.5 mV) (p 1⁄4 NS)
Pre-implant mapping for the ideal sensing location on the chest was used in 43% of the procedures; no difference was noted in the sensed R-wave amplitude between those using the standard implant technique at I (1.29 mV vs 1.26 mV) or F (1.48 mV vs 1.18 mV) (p 1⁄4 NS)
Summary
An implantable loop recorder (ILR) is an ambulatory device used for the detection of arrhythmias over a prolonged period of time.[1] A novel ILR, the Reveal LINQt Insertable Cardiac Monitor (Medtronic, Minneapolis, MN), has been approved by the United States Food and Drug. Reveal LINQTM Loop Recorder in Pediatric Patients. The Reveal LINQt (Medtronic, Minneapolis, MN) has an improved algorithm for the detection of both P waves and R waves, which correspond to the signals for atrial and ventricular depolarization, respectively, on the standard electrocardiogram.[7,8] This algorithm has been validated in adult patients to assist in P-wave detection.[9,10] Further research has demonstrated that a sensed R-wave amplitude of at least 0.2 mV is required for arrhythmia detection.[11]
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