Sensing performance, safety, and patient acceptability of long-dipole cardiac monitor: An innovative axillary insertion.

Abstract

The recommended location for implantable cardiac monitor (ICM) insertion is the left pectoral region. We tested whether an innovative left axillary implantation approach could be applicable for a new ICM, characterized by a long sensing dipole. We considered a series of 55 patients consecutively implanted with a long-dipole ICM (BioMonitor 2); the first 30 subjects underwent prepectoral location insertion, while the subsequent 25 received the ICM in the axillary region. Sensing performances collected at 1-month follow-up were compared between the two groups. During the visit, each patient was also asked to fill in a brief questionnaire to assess patient acceptability of the device. All patients had a successful insertion of ICM. Mean R-wave amplitude was 0.87 ± 0.44mV in the prepectoral group and 1.00 ± 0.45mV in the axillary one, without any significant difference. The percentage of patients with visible P wave was also comparable between the two approaches (65.5%vs 68.2%, P=0.84). None of the patients reported device-related issues or discomfort, and ICM was generally well accepted and tolerated by all the involved patients. Axillary insertion may represent a valid alternative to the standard one for long-dipole ICM technology providing not only patient acceptability but also high-quality sensing performances.