Physician workload related to ILR false alarms in the era of telemedicine

Implantable loop recorders (ILR) are an effective tool for the management of different clinical settings, and they have been used widely over past years. In patients with ILR, remote monitoring is now-days a must according to recent HRS guidelines [1] but it necessitates of clinical management and physician’s attention. The number of false alarms detected by these devices is up to 69.7% [2] and, therefore, the amount of workload needed to filter all the alarms is incompatible with normal clinical practice.

Underline the need for better management of remote monitoring, analyzing types of alarms, their frequency and suggesting what we could change in clinical practice to reduce the rate of false alarms.

Our unit developed a protocol in which implant is driven by non-invasive electrical mapping of the R wave over and around the precordial zone, not limited to the parasternal zone. We enrolled 104 patients and retrospectively analyzed: 1. the number of false alarms; 2. the type of false alarms; 3. the implant protocol used and its correlation with false alarms. We also analyzed its consequent impact in clinical practice.

38 patients underwent ILR implant with the protocol developed by our unit: mean sensing was 1 mV [0.6-1.3], the rate of false alarms was 0% (n=0). 66 Patients underwent ILR implantation using standard protocol suggested by the manufacturers: mean sensing was 0.3 mV [0.1-1.1], the rate of false alarms was 31.8% (n=21). Remote management of false alarms was straightforward when they were caused by under or oversensing. More time consuming was unveiling false diagnosed atrial fibrillation (which happened to be 52% of false alarms, in line with literature [2] ).

Enhancing the R-Wave sensing of the ILR not only reduces the frequency of under and over sensing but significantly improves the capacity of ILR algorithm to appropriately diagnose AF. Performing implant protocol that we developed drastically reduces physician’s workload related to telemedicine (31% in our cohort).

Type of false alarms