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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.

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