Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Comparison of p-wave detection of the BioMonitor III, Confirm Rx and Reveal Linq implantable loop recorders.

A. Cretnik1, T. Schreiber1, P. Schauerte2, F. Blaschke3, P. Lacour3, V. Tscholl1, P. Nagel1, U. Landmesser1, M. Huemer1, P. Attanasio1

1Campus Benjamin Franklin, Department of Cardiology, Charite Universitaetsmedizin Berlin, Berlin; 2Praxis für Kardiologie-Rhythmologie, Herzmedizin-Berlin, Berlin; 3Campus Virchow Klinikum, Department of Cardiology, Charite Universitaetsmedizin Berlin, Berlin;

Introduction Implantable loop recorders (ILR) are used for long-term cardiac rhythm monitoring. Rhythm assessment is usually made by interpreting R-R intervals. Rhythm confirmation is facilitated in cases when p-wave detection on EGMs is possible. The three most commonly used implantable loop recorders (BioMonitor III, Biotronik, Berlin, Germany; Confirm RX, St Jude Medical, Sylmar, USA and Reveal Linq Medtronic, MN, USA) differ in size, electrode placement and filter algorithms. Therefore, P-Wave visibility and amplitude on EGM may vary according to the implanted device. This study is the first to compare p-wave detection capability of the BioMonitor III, Confirm Rx and Reveal Linq implantable loop recorders. Methods ILRs were implanted according to the manufacturers recommendations. P-wave visibility and amplitude were evaluated on 30-second EGMs with standard resolution (25 mm/mV for Biotronik and St. Jude, 30 mm/mV for Medtronic). Analysis was repeated with maximum magnification. Additionally, baseline characteristics and 12 lead-ECG properties (P-Wave amplitude in leads lead I, II and V2) were documented. Results 148 consecutive patients (37% female, average age 62.31 + 13.73) with implanted BioMonitor III (n=48), Confirm Rx (n=51) and Reveal Linq (n=49) ILRs were included. Baseline characteristics and p-wave properties in 12-lead EGG were not different between the three groups (see table 1). Average p-wave amplitude was 0.05 mV (IQR 0.04-0.07) for the BioMonitor III (0.03 mV (IQR 0.02-0.04) for Confirm Rx and 0.03 mV (0.02-0.047) for Reveal Linq, see picture 1; p<0.001). Without magnification, P-waves were visible in 39 of 48 patients (81%) with BioMonitor III, 36 of 51 patients (71%) with Confirm Rx and 35 of 49 patients (71%) with Reveal Linq. With maximum magnification, P-waves could not be seen in one patient with BioMonitor III (2%), six patients with Confirm Rx (12%) and one patient with Reveal Linq ILR (2%). Conclusion Due to a longer sensing vector, detected p-wave amplitudes were higher in patients with implanted Biomonitor III. In this study cohort this did not lead to a higher likelyhood of p-wave visibility.

https://dgk.org/kongress_programme/ht2021/P318.htm