Abstract
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 RxTM devices with ≥90 days of remote
transmission history was 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 1 TP EGM), and any diagnostic delay (from
the first TP), were calculated vs. reviewing all EGMs.
Results : In 1,000 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 95716 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 vs. reviewing all EGMs.
Conclusions : 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.