Real-world evaluation of the positive predictive value and transmission burden of a novel implantable cardiac monitor: insights from a single-center experience

Background Implantable cardiac monitors (ICMs) are widely used for long-term arrhythmia surveillance but are often limited by high false-positive alert rates, increasing the workload for device clinics. The LUX-Dx ICM incorporates dual-stage detection algorithms and remote reprogramming capabilities designed to enhance diagnostic accuracy and workflow efficiency. Objective To evaluate the real-world performance of the LUX-Dx ICM across all arrhythmia types, focusing on positive predictive value (PPV), transmission burden, and the impact of remote reprogramming. Methods We retrospectively analyzed 133 consecutive patients implanted with a LUX-Dx ICM between July 2023 and October 2024. Device episodes and transmissions were reviewed over a median follow-up of 13 months. PPV was assessed at both the patient and episode levels, and changes in PPV before and after remote reprogramming were evaluated. Results A total of 55,064 episodes and 5,192 transmissions were recorded (4.0 episodes and 1.2 transmissions per patient-month). Overall patient-level PPV was 87%, highest for bradycardia (100%) and lowest for pauses (71%). Episode-level PPV was 82% (95% CI: 82-83). Remote reprogramming was performed in 34% of patients and significantly improved episode-level PPV (from 77% to 87%, p<0.001) (Figure). Review strategies focusing on the first, longest, or fastest episode per transmission yielded comparable PPVs. Conclusions In routine clinical practice, the LUX-Dx ICM demonstrated high detection accuracy across arrhythmia types. Remote reprogramming further improved performance and reduced false-positive alerts, supporting the integration of advanced algorithms and remote management features to optimize ICM workflows and alleviate the alert burden in device clinics.