Dataset Information

Analysis of the determining factors of detectable P-wave and amplitude of QRS complex sensed by implantable loop recorder.

ABSTRACT:

Background

Determining factors for sufficient QRS amplitude and discernible P-wave sensing in implantable loop recorder (ILR) are unknown. We aimed to investigate determining factors and ILR implantation angle that may improve QRS complex and P-wave sensing in ILR.

Methods

We retrospectively reviewed 220 patients who underwent ILR implantation or follow-up analysis. Patient demographic, clinical, echocardiography, electrocardiography, heart angle, and ILR angle data were collected as predictor variables. Associations between ILR QRS amplitude/P-wave detectability and each predictor variable were investigated.

Results

Univariate linear regression showed that ILR QRS amplitude was significantly associated with age, height, ILR angle, and QRS amplitudes of 12-lead electrocardiogram (ECG) (lead I, II, aVR [inverted aVR], aVF, V1-V6) and Holter ECG (lead V3, V5). Among discrete variables, only left ventricular hypertrophy (LVH) affected ILR QRS amplitude (P = .016). A multivariate linear regression analysis revealed that ILR angle (β = -0.008, P < .001), lead aVR amplitude (β = 0.469, P = .003), Holter lead V5 amplitude (β = 0.116, P = .049), Age (β = -0.005, P = .014), and LVH (β = 0.213, P = .031) were independent determinants of ILR QRS amplitude. Logistic regression revealed that heart angle significantly affected ILR P-wave detectability (β = 0.12, P = .008). Multiple logistic regression revealed that heart angle (β = 0.121, P = .013) and lead V1 amplitude (β = 28.1, P = .034) were independent determinants of ILR P-wave detectability.

Conclusion

ILR insertion angle, lead aVR QRS amplitude, Holter lead V5 QRS amplitude, age, and LVH are determinants of ILR QRS amplitude. Heart angle and lead V1 P-wave amplitude of 12-lead ECG are determinants of ILR P-wave detectability.

SUBMITTER: Ahn JH

PROVIDER: S-EPMC8339105 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Implantable loop recorders (ILRs) are conventionally utilized to elucidate the mechanism of atypical syncope. The objective of this study was to assess the impact of these devices on management of pediatric patients with known or suspected inherited arrhythmia syndromes.A retrospective chart review was undertaken of all pediatric patients with known or suspected inherited arrhythmia syndromes in whom an ILR was implanted from 2008 to 2015. Captured data included categorization of diagnosis, treatment, transmitted tracings, and the impact of ILR tracings on management. Transmissions were categorized as symptomatic, autotriggered, or routine. Actionable transmissions were abnormal tracings that directly resulted in a change of medical or device therapy. A total of 20 patients met the stated inclusion criteria (long QT syndrome, n=8, catecholaminergic polymorphic ventricular tachycardia,n=9, Brugada syndrome, n=1, arrhythmogenic right ventricular cardiomyopathy, n=2), with 60% of patients being genotype positive. Primary indication for implantation of ILR included ongoing monitoring +/- symptoms (n=15, 75%), suspicion of noncompliance (n=1, 5%), and liberalization of recommended activity restrictions (n=4, 25%). A total of 172 transmissions were received in patients with inherited arrhythmia syndromes, with 7% yielding actionable data. The majority (52%) of symptom events were documented in the long QT syndrome population, with only 1 tracing (5%) yielding actionable data. Automatic transmissions were mostly seen in the catecholaminergic polymorphic ventricular tachycardia cohort (81%), with 21% yielding actionable data. There was no actionable data in routine transmissions.ILRs in patients with suspected or confirmed inherited arrhythmia syndromes may be useful for guiding management. Findings escalated therapies in 30% of subjects. As importantly, in this high-risk population, the majority of symptom events represented normal or benign rhythms, reassuring patients and physicians that no further intervention was required.