Clinical outcomes associated with Insertable cardiac monitor implantation in Korea: A Nationwide claims data analysis

Background

Insertable cardiac monitors (ICMs) are valuable diagnostic tools for detecting cardiac arrhythmias, yet their nationwide implications remain underreported. We aimed to assess comprehensive outcome data for the Korean population receiving ICM insertions.

Methods

Using a Korean nationwide claims database, patients who underwent ICM insertion from 2010 to 2021 (N = 3152) were selected. The subjects were divided into three groups based on the indication of the procedure: recurrent syncope (n = 1389), palpitation (n = 146), cryptogenic stroke (n = 994) and unidentifiable (n = 623). The clinical outcomes, including new diagnoses of arrhythmias and therapeutic interventions following ICM insertion, were evaluated in each group.

Results

Median follow-up duration was 18.5 months (interquartile range: 7.3–33.7). In the syncope group, pacemaker and implantable cardioverter defibrillator were implanted in 396 (28.5 %) and 27 (1.9 %) patients following ICM insertion. Age (≥70 vs. <60, Hazard ratio [HR]: 2.090, p < 0.001) and prevalent atrial fibrillation (AF) or flutter (AFL)(HR: 1.891, p < 0.001) were independent risk factors for the cardiac device therapy. In the palpitation group, various arrhythmias, including AF/AFL (n = 7), supraventricular tachycardia (n = 2), and other arrhythmias (n = 13), were identified in 19 (13.6 %) patients. In the cryptogenic stroke group, new-onset AF/AFLs occurred in 91 (9.7 %) patients. The initiation of direct oral anticoagulants was noted in 8.9 % of anticoagulation-naïve cryptogenic stroke patients during follow-up.

Conclusions

ICM insertion led to significant diagnostic and therapeutic interventions across all indication groups, with notable rates of device implantation and arrhythmia detection. These findings underscore the clinical value of ICMs in guiding patient management and improving outcomes across various cardiac conditions.