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Accuracy of Implantable Loop Recorders: Multicenter, Multidevice Comparison.

Suraya H Kamsani1, Melissa E Middeldorp2, Shaun Evans2

  • 1Centre for Heart Rhythm Disorders, Adelaide University and Royal Adelaide Hospital, Adelaide, South Australia, Australia; Cardiology Department, National Heart Institute, Kuala Lumpur, Malaysia.

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Summary
This summary is machine-generated.

Implantable loop recorders (ILRs) show varied accuracy in detecting arrhythmias, with many false alerts increasing clinical workload. Improvements in ILR alert algorithms are necessary to reduce this burden.

Keywords:
arrhythmia detectionfalse-positive alertsimplantable loop recorder (ILR)remote monitoring

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Area of Science:

  • Cardiology
  • Medical Devices
  • Digital Health

Background:

  • Implantable loop recorders (ILRs) are crucial for long-term cardiac monitoring.
  • However, frequent false-positive alerts from ILRs significantly increase the clinical burden on healthcare providers.

Purpose of the Study:

  • To evaluate and compare the arrhythmia detection accuracy of four leading ILR devices.
  • The study specifically assessed Medtronic LINQ II, Boston Scientific LUX-Dx, Biotronik Biomonitor III, and Abbott Confirm Rx.

Main Methods:

  • A large, multicenter database of 437,351 ECG-verified episodes from 6,756 patients was utilized.
  • A random sample of 1,140 patients was selected for detailed analysis, with alerts adjudicated by physicians.

Main Results:

  • Boston Scientific LUX-Dx showed the highest positive predictive values (PPVs) for atrial tachycardia/AF and bradycardia detection.
  • Medtronic LINQ II and Abbott Confirm Rx had moderate PPVs, while Biotronik Biomonitor III demonstrated the lowest PPVs for atrial tachycardia/AF.
  • Pause detection was poorest with Abbott Confirm Rx, largely due to undersensing, while Boston Scientific LUX-Dx performed best.

Conclusions:

  • Current implantable loop recorders exhibit variable accuracy in arrhythmia detection.
  • Despite algorithmic enhancements, a significant number of false-positive alerts persist across all tested devices.
  • Further advancements in ILR alert algorithms are essential to mitigate the clinical burden associated with false alerts.