Introduction
Since their inception, insertable cardiac monitors (ICMs) quickly became established as an invaluable tool for ambulatory diagnosis of cardiac arrhythmias, specifically atrial fibrillation (AF), tachycardia (including SVT and VT), bradycardia, and asystole (i.e., pause).1–6 ICMs continually monitor the subcutaneous electrogram (EGM), store EGM clips to memory when arrhythmia episodes of interest are detected, and transmit those EGMs to an online patient care network for clinician review and patient diagnosis. However, many EGMs do not present new or actionable information. For example, recurring arrhythmias may result in redundant EGMs of similar rate and/or duration; diagnostically, the same information could be conveyed by a single EGM along with the total episode count and duration. Suboptimal device placement, improper programming, or arrhythmia detection algorithm imperfections may also trigger EGMs that are not associated with a true arrhythmia.7–10 Consequently, clinicians may be forced to manually adjudicate more EGMs than necessary to reach the same diagnosis.
In response to the growing volume of ICMs implanted, and thus EGMs to review, efforts have been made to limit the burden of EGMs transmitted to clinicians. This study describes the retrospective analysis of a novel EGM prioritization strategy that can be enabled on the manufacturer’s patient care network, with the goal of reducing the unnecessary EGM review burden imposed on ICM customers while minimizing any delay to diagnosis.