Key result
Key electrogram selection cuts review burden ~55% while maintaining same-day arrhythmia diagnosis in 99% of devices.
Why the study?
Insertable cardiac monitors require time-consuming manual adjudication of electrograms for definitive arrhythmia diagnosis, motivating an evaluation of the clinical impact of selecting only key electrograms for review.
Observational (n=1,000)
May reduce ICM EGM review burden in practice; leaves open whether selective adjudication preserves accuracy without prospective validation.
BACKGROUND: Insertable cardiac monitors (ICMs) are essential for ambulatory arrhythmia diagnosis. However, definitive diagnoses still require time-consuming, manual adjudication of electrograms (EGMs). OBJECTIVE: To evaluate the clinical impact of selecting only key EGMs for review. METHODS: Retrospective analyses of randomly selected Abbott Confirm Rx™ devices with ≥90 days of remote transmission history were performed, with each EGM adjudicated as true or false positive (TP, FP). For each device, up to 3 "key EGMs" per arrhythmia type per day were prioritized for review based on ventricular rate and episode duration. The reduction in EGMs and TP days (patient-days with at least one TP EGM), and any diagnostic delay (from the first TP), were calculated versus reviewing all EGMs. RESULTS: In 1000 ICMs over a median duration of 8.1 months, at least one atrial fibrillation (AF), tachycardia, bradycardia, or pause EGM was transmitted by 424, 343, 190, and 325 devices, respectively, with a total of 95 716 EGMs. Approximately 90% of episodes were contributed by 25% of patients. Key EGM selection reduced EGM review burden by 43%, 66%, 77%, and 50% (55% overall), while reducing TP days by 0.8%, 2.1%, 0.2%, and 0.0%, respectively. Despite reviewing fewer EGMs, 99% of devices with a TP EGM were ultimately diagnosed on the same day versus reviewing all EGMs. CONCLUSION: Key EGM selection reduced the EGM review substantially with no delay-to-diagnosis in 99% of patients exhibiting true arrhythmias. Implementing these rules in the Abbott patient care network may accelerate clinical workflow without compromising diagnostic timelines.
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Gardner et al. (2022) conducted an observational in Cardiac arrhythmias requiring ambulatory monitoring (n=1,000). Key electrogram (EGM) selection (up to 3 key EGMs per arrhythmia type per day) vs. Reviewing all EGMs was evaluated on Reduction in electrogram (EGM) review burden, reduction in true positive (TP) days, and same-day diagnosis of devices with a TP EGM (55% overall reduction in EGM review burden). Key electrogram selection reduced overall review burden by 55% vs reviewing all electrograms, while diagnosing 99% of devices with true positive arrhythmias on the same day.
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