The sensitivity of ECG contamination to surgical implantation site in adaptive neurostimulation

Background Brain sensing devices are approved today for Parkinson’s, essential tremor, and epilepsy therapies. Clinical decisions for implants are often influenced by the premise that patients will benefit from using sensing technology. However, artifacts, such as ECG contamination, can render such treatments unreliable. Therefore, clinicians need to understand how surgical decisions may affect artifact probability. Objectives Investigate neural signal contamination with ECG activity in sensing enabled neurostimulation systems, and in particular clinical choices such as implant location that impact signal fidelity. Methods Electric field modelling and empirical signals from 85 patients were used to investigate the relationship between implant location and ECG contamination.a Results The impact on neural recordings depends on the difference between ECG signal and noise floor of the electrophysiological recording. Empirically, we demonstrate that severe ECG contamination was more than 3.2x higher in left-sided subclavicular implants (48.3%), when compared to right-sided implants (15.3%). Cranial implants did not show ECG contamination. Conclusions Given the relative frequency of corrupted neural signals, we conclude that implant location will impact the ability of brain sensing devices to be used for “closed-loop” algorithms. Clinical adjustments such as implant location can significantly affect signal integrity and need consideration. Highlights ### Competing Interest Statement Dr. Neumann has nothing to disclose. Dr. Majid Memarian Sorkhabi has nothing to disclose. Mr. Benjaber has nothing to disclose. Dr. Feldmann has nothing to disclose. Dr. Saryyeva has nothing to disclose. Dr. Krauss reports personal fees from Medtronic, personal fees from Boston Scientific, outside of the submitted work. Dr. Contarino reports non-financial support from Boston Scientific, grants and other from Medtronic, other from CHDR, grants from AbbVie, non-financial support from Global Kinetics Corporation, outside the submitted work. Dr. Tinkhauser has nothing to disclose. Dr. Pollo received consultancy fees from Boston and Abbott and is Co-founder of Aleva Neurotherapeutics, outside of the submitted work. Dr. Sieger has nothing to disclose. Dr. Jech reports honoraria and consultancies from Ipsen, Desitin and Cardion, outside the submitted work. Dr. Palmisano has nothing to disclose. Dr. Isaias reports honoraria from Medtronic Inc and grants from Newronika Srl, outside the submitted work. Dr. Cummins has nothing to disclose. Dr. Little has nothing to disclose. Dr. Starr reports research support, in the form of investigational devices provided at no charge, from Medtronic Inc., outside the submitted work. Dr Kokkinos has nothing to disclose. Dr. Schneider reports Speakers honoraria from Medtronic, Abbot and Boston Scientific, outside of the submitted work. Dr. Herrington discloses personal fees from Medtronic and Boston Scientific, outside the submitted work. Dr. Brown reports grants and personal fees from Medtronic, outside the submitted work. Dr. Kuehn is in the advisory board of Medtronic and Boston Scientific and reports personal fees from Medtronic and Boston Scientific, outside the submitted work. Dr. Denison reports personal fees from Medtronic, during the conduct of the study; other from Bioinduction (cranial mount system), outside the submitted work.