Premature explantation of implantable cardiac monitors

Implantable cardiac monitors (ICMs) are increasingly utilized for a variety of clinical indications. Multiple models from different manufacturers are available, each varying in size, shape, battery life, and functionality.

This study aims to assess the incidence of premature ICM explantation, identify the reasons for premature explantation, and compare these outcomes across different manufacturers.

Data on all ICM implantations performed at our center since January 2020 were collected within a prospective registry. Follow-up of the status of each ICM was evaluated for all patients. The primary endpoint was defined as premature explantation due to ICM malfunction, early battery depletion, ICM infection or patient discomfort. Early battery depletion was defined as depletion occurring within the first two years post-implant. Patients who died, transferred remote monitoring to an external site, discontinued monitoring after diagnosis or upon physician decision, or were lost to follow-up were censored.

A total of 923 patients were included in the study (mean age 64.4 years; 31.5% women). The indications for ICM implantation were cryptogenic ischemic stroke in 307 patients (33.4%), syncope in 127 (13.8%), follow-up after atrial fibrillation ablation in 2 (0.2%), palpitations in 8 (0.9%), enrollment in a study protocol in 431 (46.8%), and other indications in 45 (4.9%). The ICMs used were manufactured by Medtronic in 572 patients (62%), Biotronik in 100 (10.8%), Boston Scientific in 184 (19.9%), and Abbott in 67 (7.3%). The mean follow-up duration was 22.7 ± 13.1 months. Premature explantation occurred in 40 patients (4.3%). The table provides a breakdown of the reasons for premature explantation overall and by manufacturer. The figure shows survival free from premature explantation by manufacturer, with statistical comparison using the Log-rank test.

Premature explantation occurs in approximately one out of every twenty-five patients with an ICM, with one device showing a higher rate of premature explantation compared to the others. The main reason for premature explantation is patient discomfort. Device malfunction, early battery depletion, and infections are rare occurrences.

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