Volume 14, Issue 7, Pages (July 2017)

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Volume 14, Issue 7, Pages 1016-1023 (July 2017) Development and validation of a dual sensing scheme to improve accuracy of bradycardia and pause detection in an insertable cardiac monitor Rod S. Passman, MD, FHRS, John D. Rogers, MD, Shantanu Sarkar, PhD, Jerry Reiland, MS, Erin Reisfeld, MS, Jodi Koehler, MS, Suneet Mittal, MD, FHRS Heart Rhythm Volume 14, Issue 7, Pages 1016-1023 (July 2017) DOI: 10.1016/j.hrthm.2017.03.037 Copyright © 2017 The Authors Terms and Conditions

Figure 1 Examples of inappropriate bradycardia and pause detections. Inappropriate bradycardia detection is primarily caused by undersensing of (A) premature ventricular contractions (PVCs), (B) normal sinus after PVCs, and (C) small R waves. Inappropriate pause detection is primarily caused by undersensing of (D) sudden drop of R-wave amplitude, (E) small R waves, (F) normal sinus following PVCs, and (G) loss of electrocardiogram due to loss of contact. The marker annotations are VS (ventricular sense), BS (bradycardia sense), BD (bradycardia detect), and AD (asystole [pause] detect). Heart Rhythm 2017 14, 1016-1023DOI: (10.1016/j.hrthm.2017.03.037) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Basic schematic of the dual sensing scheme used to reduce inappropriate bradycardia and pause detections. ECG = electrocardiogram. Heart Rhythm 2017 14, 1016-1023DOI: (10.1016/j.hrthm.2017.03.037) Copyright © 2017 The Authors Terms and Conditions

Figure 3 Auto-adjusting sensing scheme (second panel) used in the current insertable cardiac monitor device that may lead to undersensing of wide-complex shortly coupled bigeminal premature ventricular contractions, leading to inappropriate bradycardia detection. The dual sense scheme (third panel) with a long blanking and fixed threshold provides a second look for long intervals sensed in the primary sense channel (second panel). ECG = electrocardiogram. Heart Rhythm 2017 14, 1016-1023DOI: (10.1016/j.hrthm.2017.03.037) Copyright © 2017 The Authors Terms and Conditions

Figure 4 Schematic of the data analysis method followed to develop and validate the dual sense enhancement. Heart Rhythm 2017 14, 1016-1023DOI: (10.1016/j.hrthm.2017.03.037) Copyright © 2017 The Authors Terms and Conditions

Figure 5 Number of true positive and false positive bradycardia/pause episode detections before and after the application of the dual sense algorithm. Heart Rhythm 2017 14, 1016-1023DOI: (10.1016/j.hrthm.2017.03.037) Copyright © 2017 The Authors Terms and Conditions

Figure 6 Examples of true bradycardia episodes missed by the dual sense algorithm in 4 patients who had a single true bradycardia episode over a 1-year follow-up, leading to reduced episode detection sensitivity and drop in diagnostic yield. Heart Rhythm 2017 14, 1016-1023DOI: (10.1016/j.hrthm.2017.03.037) Copyright © 2017 The Authors Terms and Conditions