16-59: Long-term experience of remote monitoring in a population with cardiac implantable electronic devices for the treatment of ventricular tachyarrythmias

Abstract

In the recent years various clinical advantages have been attributed to remote monitoring (RM) in patients (P) with cardiac implantable electronic devices (CIED). These benefits include early detection of events and of device dysfunction, reduction of inappropriate therapies and mortality, in P with implantable cardioverter defibrillator (ICD), and also hospital admissions for decompensated heart failure (HF) in P with cardiac resynchronization therapy-defibrillator (CRT-D). Aim: To evaluate the long-term clinical impact of a RM program in a population with left ventricular systolic dysfunction and devices (ICD/CRT-D) implanted for the treatment of ventricular tachyarrythmias (VT/VF). Methods: Retrospective study of 426 P with ICD (n = 300) or CRT-D (n = 126) under a RM program since 2007, with analysis of computerized registry of data. The program included daily analysis of events marked as “alerts“, transmission of data ( parameters, battery data, list of “alerts” and events) every 3 months (remote consultation) as well as annual outpatient visit. Results: In 79% of P, a CIED was implanted for primary prevention of arrhythmic death. The mean age was 58 + 11 years, with a predominance of male gender (333 P, 78%). During a follow-up of 3.7 + 1.6 years the mean value of “alerts” for each P was 6.7 + 5.1. Reasons for “alerts” were the detection of asymptomatic episodes of VT (treated with anti-tachycardia pacing in 4.5%; self-terminating episodes in 20%), atrial fibrillation/flutter (7%), inadequate percentages of biventricular pacing in 4.5%, changes of intrathoracic impedance (4.2%) and inadequate values for threshold/impedance of electrodes (3.8%). Inappropriate shocks rate corresponded to 4% of a total number of 212 shocks from the beginning of RM. In 17% of P a clinical intervention was driven by “alerts” (modification of the medication, substitution of electrodes, internal electrical cardioversion or ablation). In 7%, there was a hospital admission due to an arrhythmia, in 1.6% because of HF and in 1.2% due to electrode dysfunction. All-cause mortality was 3% and 0.5% underwent heart transplantation. Conclusions: In P with CIED, long-term follow-up with RM allowed frequent early detection of events, leading to timely therapeutic interventions in a significant number of P. These results may account for the low rates of hospitalization and mortality, reassuring the growing potential of this follow-up modality.