Monitoring of Remotely Reprogrammable Implantable Loop Recorders With Algorithms to Reduce False-Positive Alerts

Implantable loop recorders (ILRs) are increasingly placed for arrhythmia detection. However, historically, ≈75% of ILR alerts are false positives, requiring significant time and effort for adjudication. The LINQII and LUX-Dx are remotely reprogrammable ILRs with dual-stage algorithms using artificial intelligence to reduce false positives, but their utility in routine clinical practice has not been studied.

We identified patients with the LINQII and LUX-Dx who were monitored by the Veterans Affairs National Cardiac Device Surveillance Program between March and June 2022. ILR programming was customized on the basis of implant indication. All alerts and every 90-day scheduled transmissions were manually reviewed. ILRs were remotely reprogrammed, as appropriate, after false-positive alerts or 2 consecutive same-type alerts, unless there was ongoing clinical need for that alert. Outcomes were total number of transmissions and false positives. We performed medical record review to determine if patients experienced any adverse clinical events, including hospitalization and mortality. Among 117 LINQII patients, there were 239 total alerts, 43 (18.0%) of which were false positives. Among 105 LUX-Dx patients, there were 300 total alerts, 115 (38.3%) of which were false positives. LINQIIs were reprogrammed 22 times, resulting in a decrease in median alerts/day from 0.13 to 0.03. LUX-Dx ILRs were reprogrammed 52 times, resulting in a decrease from 0.15 to 0.01 median alerts/day. There were no adverse clinical events that could have been identified by superior or earlier arrhythmia detection.

ILRs with artificial intelligence algorithms and remote reprogramming ability are associated with reduced alert burden because of higher true-positive rates than prior ILRs, without missing potentially consequential arrhythmias.