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Reducing the Electrogram Review Burden Imposed by Insertable Cardiac Monitors
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  • Roy S. Gardner,
  • Fabio Quartieri,
  • Tim Betts,
  • Muhammad Afzal,
  • Harish Manyam,
  • Nima Badie,
  • Fady Dawoud,
  • Leyla Sabet,
  • Kevin Davis,
  • Fujian Qu,
  • Kyungmoo Ryu,
  • John Ip
Roy S. Gardner
Golden Jubilee National Hospital

Corresponding Author:[email protected]

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Fabio Quartieri
Arcispedale Santa Maria Nuova di Reggio Emilia
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Tim Betts
NIHR Oxford Biomedical Research Centre
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Muhammad Afzal
The Ohio State University Wexner Medical Center Division of Cardiovascular Medicine
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Harish Manyam
Erlanger Health System
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Nima Badie
Abbott Cardiovascular - Sylmar California
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Fady Dawoud
Abbott Cardiovascular - Sylmar California
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Leyla Sabet
Abbott Cardiovascular - Sylmar California
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Kevin Davis
Abbott Cardiovascular - Sylmar California
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Fujian Qu
Abbott Cardiovascular - Sylmar California
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Kyungmoo Ryu
Abbott Cardiovascular - Sylmar California
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John Ip
Sparrow Hospital
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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 TM 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.
09 Dec 2021Submitted to Journal of Cardiovascular Electrophysiology
09 Dec 2021Submission Checks Completed
09 Dec 2021Assigned to Editor
09 Dec 2021Reviewer(s) Assigned
17 Dec 2021Review(s) Completed, Editorial Evaluation Pending
19 Dec 2021Editorial Decision: Revise Minor
24 Jan 20221st Revision Received
24 Jan 2022Submission Checks Completed
24 Jan 2022Assigned to Editor
24 Jan 2022Reviewer(s) Assigned
28 Jan 2022Review(s) Completed, Editorial Evaluation Pending
31 Jan 2022Editorial Decision: Accept
Apr 2022Published in Journal of Cardiovascular Electrophysiology volume 33 issue 4 on pages 741-750. 10.1111/jce.15397