Analysis of the determining factors of detectable P-wave and amplitude of QRS complex sensed by implantable loop recorder

Jang Ho Ahn, Hyunho Ryu, Il Young Oh, Youngjin Cho, Ji Hyun Lee

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Determining factors for sufficient QRS amplitude and discernible P-wave sensing in implantable loop recorder (ILR) are unknown. We aimed to investigate determining factors and ILR implantation angle that may improve QRS complex and P-wave sensing in ILR. Methods: We retrospectively reviewed 220 patients who underwent ILR implantation or follow-up analysis. Patient demographic, clinical, echocardiography, electrocardiography, heart angle, and ILR angle data were collected as predictor variables. Associations between ILR QRS amplitude/P-wave detectability and each predictor variable were investigated. Results: Univariate linear regression showed that ILR QRS amplitude was significantly associated with age, height, ILR angle, and QRS amplitudes of 12-lead electrocardiogram (ECG) (lead I, II, aVR [inverted aVR], aVF, V1–V6) and Holter ECG (lead V3, V5). Among discrete variables, only left ventricular hypertrophy (LVH) affected ILR QRS amplitude (P =.016). A multivariate linear regression analysis revealed that ILR angle (β = −0.008, P <.001), lead aVR amplitude (β = 0.469, P =.003), Holter lead V5 amplitude (β = 0.116, P =.049), Age (β = −0.005, P =.014), and LVH (β = 0.213, P =.031) were independent determinants of ILR QRS amplitude. Logistic regression revealed that heart angle significantly affected ILR P-wave detectability (β = 0.12, P =.008). Multiple logistic regression revealed that heart angle (β = 0.121, P =.013) and lead V1 amplitude (β = 28.1, P =.034) were independent determinants of ILR P-wave detectability. Conclusion: ILR insertion angle, lead aVR QRS amplitude, Holter lead V5 QRS amplitude, age, and LVH are determinants of ILR QRS amplitude. Heart angle and lead V1 P-wave amplitude of 12-lead ECG are determinants of ILR P-wave detectability.

Original languageEnglish
Pages (from-to)1069-1076
Number of pages8
JournalJournal of Arrhythmia
Volume37
Issue number4
DOIs
StatePublished - Aug 2021

Keywords

  • ECG monitoring
  • P-wave detection
  • QRS amplitude
  • implantable loop recorder

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