131-06: Is Remote Monitoring Less Useful for Secondary Indications for ICD Implant?

Abstract

Introduction: To streamline post-implant follow up of patients ( pts) receiving ICDs, recent recommendations advocate a system based on automatic remote monitoring (RM) with minimized in person evaluations (IPE). However, they do not distinguish among differing implant indications. Conceivably, those with recurrent ventricular arrhythmias seek and/or require greater in hospital attention, resulting in increased unscheduled IPEs, which may blunt advantage of RM. We tested this in the TRUST trial. Methods: 1339 patients receiving ICD therapy for Class I and IIa indications were randomized post-implant 2:1 to RM or to conventional monitoring (CM), with follow-up checks scheduled at 3, 6, 9, 12 and 15 months post-implant. Conventional pts were evaluated with IPE only. In RM, only 3 and 15 month checks were IPE based, ie pts were monitored remotely only for an entire year without scheduled appointment. Any IPEs occurring between scheduled time points in either arm were “unscheduled” Total and unscheduled IPEs were contrasted in both study arms for primary and secondary ICD implant indications. Results: Overall, RM and conventional pts were similar (age 63.3 +12.8 vs 64.0 + 12.1 years; gender 72.0% vs 73.1% male; and dual-chamber implants 57.8% vs 56.6%). These demographics were similar among pts implanted for primary vs secondary indications but differed for LVEF (26.8 + 8.2 vs 37.0 +13.7%, respectively, p ≥ 0.001). Overall, HM reduced total in-hospital device evaluations by 45% (Figure Left). Among pts receiving ICDs for secondary vs primary indications, conventional management was associated with a twofold increase in unscheduled hospital based encounters, but with RM there was no difference (Figure Right). Conclusion: Advantages of RM are increased in patients at high risk of recurrent ventricular arrhythmias (Figure Presented).