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.