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https://hdl.handle.net/2440/139111
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dc.contributor.author | Pitman, B.M. | - |
dc.contributor.author | Zanker, A. | - |
dc.contributor.author | Lim, M. | - |
dc.contributor.author | McLoughney, J. | - |
dc.contributor.author | Spinelli, J. | - |
dc.contributor.author | Tarone, R. | - |
dc.contributor.author | McInnes, K. | - |
dc.contributor.author | Heath, K.M. | - |
dc.contributor.author | Gieve, M. | - |
dc.contributor.author | Evans, S. | - |
dc.contributor.author | Young, G.D. | - |
dc.contributor.author | Roberts-Thomson, K.C. | - |
dc.contributor.author | Wong, C.X. | - |
dc.contributor.author | Sanders, P. | - |
dc.contributor.author | Lau, D.H. | - |
dc.date.issued | 2023 | - |
dc.identifier.citation | Heart Rhythm, 2023; 20(9):1297-1306 | - |
dc.identifier.issn | 1547-5271 | - |
dc.identifier.issn | 1556-3871 | - |
dc.identifier.uri | https://hdl.handle.net/2440/139111 | - |
dc.description | Published September 2023 | - |
dc.description.abstract | Background: Fidelity of electrogram sensing may reduce false alerts from insertable cardiac monitor (ICM). Objective: To assess impact of vector length, implant angle and patient factors on electrogram sensing using surface electrocardiogram (EKG) mapping. Methods: Twelve separate precordial single-lead surface EKGs were acquired from 150 participants at two inter-electrode distance (75mm & 45mm), three vector angles (vertical, oblique, horizontal) and in two postures (upright & supine). A subset of fifty patients also received a clinically indicated ICM implant in 1:1 ratio (Medtronic Reveal LINQ:Biotronik Biomonitor III). All EKG and ICM electrogram were analyzed by blinded investigators using DigitizeIt software. P-wave visibility threshold was set at >0.015mV. Logistic regression was used to identify factors impacting P-wave amplitude. Results: A total of 1,800 tracings from 150 participants [44.5% female, median 59 years old] were assessed. Median P- and R-wave were 45% and 53% larger with vector length of 75 vs. 45mm respectively (both p<0.001). The oblique orientation yielded the best P- and R-wave sensing while posture change did not impact on P-wave amplitude. Mixed effects modeling found that visible P-waves occur more frequently with vector length of 75mm than 45mm (86% vs. 75% respectively, p<.0001). A longer vector length improved both P-wave amplitude and visibility in all BMI categories. There was moderate correlation of P- and R-waves from the ICM electrogram to surface EKG recordings (ICC 0.74 and 0.80, respectively). Conclusion: Longer vector length and oblique implant angle yielded the best electrogram sensing and are relevant considerations for ICM implantations. | - |
dc.description.statementofresponsibility | Bradley M. Pitman, Amy Zanker, Matthew Lim, Joshua McLoughney, Jade Spinelli, Rachel Tarone, Kristie McInnes, Kyle M. Heath, Mahsa Gieve, Shaun Evans, Glenn D. Young, Kurt C. Roberts-Thomson, Christopher X. Wong, Prashanthan Sanders, Dennis H. Lau | - |
dc.language.iso | en | - |
dc.publisher | Elsevier | - |
dc.rights | © 2023 Heart Rhythm Society. All rights reserved. | - |
dc.source.uri | http://dx.doi.org/10.1016/j.hrthm.2023.05.034 | - |
dc.subject | Insertable cardiac monitor; ECG mapping; Electrogram sensing; P-wave visibility; Vector length | - |
dc.title | Factors affecting electrogram sensing in insertable cardiac monitor: Insights from surface electrocardiogram mapping analysis | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1016/j.hrthm.2023.05.034 | - |
dc.relation.grant | NHMRC | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Evans, S. [0000-0001-5067-2743] | - |
dc.identifier.orcid | Wong, C.X. [0000-0002-1913-6675] | - |
dc.identifier.orcid | Sanders, P. [0000-0003-3803-8429] | - |
dc.identifier.orcid | Lau, D.H. [0000-0001-7753-1318] | - |
Appears in Collections: | Medicine publications |
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