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.