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 modeling and empirical signals from 85 patients were used to investigate the relationship between implant location and ECG contamination. 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.

Department of Neurological Surgery University of California San Francisco San Francisco CA 94143 USA

Department of Neurology Bern University Hospital and University of Bern Bern Switzerland

Department of Neurology Charles University 1st Faculty of Medicine and General University Hospital Prague Czech Republic

Department of Neurology Leiden University Medical Center Leiden the Netherlands; Department of Neurology Haga Teaching Hospital The Hague the Netherlands

Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston MA USA

Department of Neurology University Hospital of Würzburg and Julius Maximilian University of Würzburg Würzburg Germany

Department of Neurology University of California San Francisco San Francisco CA 94143 USA

Department of Neurosurgery Bern University Hospital and University of Bern Bern Switzerland

Department of Neurosurgery Charité Universitätsmedizin Berlin Chariteplatz 1 10117 Berlin Germany

Department of Neurosurgery Massachusetts General Hospital and Harvard Medical School Boston MA USA

Department of Neurosurgery Medizinische Hochschule Hannover Hannover Germany

Movement Disorder and Neuromodulation Unit Department of Neurology Charité Universitätsmedizin Berlin Chariteplatz 1 10117 Berlin Germany

MRC Brain Network Dynamics Unit Nuffield Department of Clinical Neurosciences University of Oxford United Kingdom

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