A Large, Real‐World Cohort Analysis of Arrhythmia Detection and Therapeutic Interventions in Patients With Insertable Cardiac Monitors and Long‐Term Monitoring

TL;DR

This study analyzes real-world data from cardiac monitors to show how often arrhythmias are detected and how often patients receive treatments based on those findings.

Contribution

The study presents the largest real-world analysis of arrhythmia detection and therapeutic interventions using AI-enabled insertable cardiac monitors.

Findings

60.6% of patients had at least one arrhythmia detected during long-term monitoring.

Over half of patients received medication adjustments or procedural interventions based on monitor findings.

Arrhythmias other than AF were detected in a significant proportion of patients with suspected AF or cryptogenic stroke.

Abstract

Insertable cardiac monitors (ICMs) provide long‐term continuous monitoring for arrhythmia diagnosis and management for various clinical indications. However, little data exists on comprehensive real‐world arrhythmia diagnostic yield and therapy rates in patients indicated for ICMs with validated artificial intelligence (AI) algorithms enabling large‐scale, automated adjudication of ICM‐detected episodes. We report the largest real‐world analysis of arrhythmia detection as well as medical and procedural therapies in patients with ICMs implanted for guideline‐approved indications with long‐term monitoring.

Patients who received a Reveal LINQ ICM between October 1, 2016, and June 30, 2020, with ≥ 1 year of follow‐up were identified in two databases (Medtronic CareLink data warehouse, N = 12 020, and Optum Clinformatics Data Mart claims database, N = 17 037) to analyze arrhythmia detections and therapeutic interventions, respectively. Patients were categorized by clinical indication for ICM placement. All device‐detected ECGs were identified and processed through arrhythmia‐specific AI algorithms. Therapeutic interventions included procedural interventions (cardiovascular implantable electronic device implantation, cardioversions, and ablations) and medication initiation or titration (antiarrhythmics, rate‐control medications, and oral anticoagulants) after ICM implant.

Mean (SD) follow‐up in the CareLink and Clinformatics claims databases was 24.6 (12.7) and 40.8 (15.6) months, respectively. Of the 12 020 patients in the arrhythmia detection analysis, 7284 (60.6%) had ≥ 1 arrhythmia detected (56.3% in the suspected AF population; 80.1% in the AF management population), and 376 (28.9%) had ≥ 2 arrhythmias detected during long‐term follow‐up. Among syncope patients with arrhythmia(s) detected, 71.2% had a finding other than pause/bradycardia; 50.4% of cryptogenic stroke patients and 62.6% of AF management patients with arrhythmias had ≥ 1 finding other than AF. Of the 17 037 patients in the therapeutic interventions analysis, 9820 (57.6%) had a therapeutic action post‐ICM insertion, with 25% of all patients receiving a procedural intervention, and > 50% undergoing a medication adjustment. Mean (SD) follow‐up to first arrhythmia detection was 7 (9) months. Mean (SD) duration from ICM insertion to therapeutic action was 13 (13) months for procedures and 7 (11) months for medication initiation.

Long‐term continuous monitoring with ICMs enables identification of multiple arrhythmias that may have otherwise remained undetected and rules out arrhythmias in ~40% regardless of indication. Medication adjustments and/or procedural interventions related to the management of arrhythmias were observed in over half of ICM recipients during long‐term follow‐up.

ICM arrhythmia detection and therapeutic interventions.

Figures