Transmission Rate of Remote Monitoring and Mortality in Patients With Pacemaker

Abstract

Background: Remote monitoring of cardiac implantable electronic devices improve clinical outcome. There was few data, however, about the association between transmission rate of remote monitoring [TR (%); days of transmission / days of follow-up ratio after remote monitoring introduction] and mortality in patients with pacemakers. Purpose(s): To investigate whether the TR can predict all-cause mortality in patients with a pacemaker. Method(s): Patients with a newly implanted a pacemaker between August 2011 and February 2018 were enrolled if they were managed using a specific remote monitoring system with daily transmissions (Biotronik, Home Monitoring). A total of 164 patients was eligible for this study (79.7 +/- 8.8 years, 50% men). We evaluated the relationship between TR and all-cause mortality. Result(s): During the follow-up period (median 2.8 years), 30 all-cause deaths were observed. There were no significant differences in sex, height, weight, or left ventricular ejection fraction between the patients with all-cause mortality and patients without events. TR was significantly lower in patients who died during the follow-up period than in those who survived (78.5 +/- 27.1 vs. 93.8 +/- 9.4%, p = 0.005). Compared with patients who survived, the patients who died were significantly older (83.9 +/- 7.5 vs. 78.7 +/- 8.8 years, p = 0.003), and had significantly higher plasma B-type natriuretic peptide (BNP) levels (211.0 [IQR, 123.0-424.4] vs. 85.9 [IQR, 45.0-216.6] pg/mL, p = 0.02). The patients who died had significantly lower estimated glomerular filtration rate (eGFR) than those survived (40.8 +/- 22.8 vs 57.4 +/- 21.3 mL/min/1.73 m2, p <0.001). The proportion of physiological pacing was significantly higher in patients who survived than in those who died (94.8 vs. 73.3 %, p <0.001). The area under the receiver-operating characteristic curve for the TR to predict all-cause death was 0.73 (95% confidence interval [CI]: 0.62-0.83, p < 0.001). A TR value of 94% had a sensitivity of 67% and a specificity of 74% for predicting all-cause mortality. In multivariate Cox regression analysis, TR >=94% was selected as a predictor of all-cause death (hazard ratio: 0.62; 95% CI: 0.41-0.93; p = 0.02). However, the other valuables entered into the model, age >= 80 years, BNP>=100 pg/mL, eGFR < 60 mL/min/1.73 m2, ventricular pacing, were not selected. Conclusion(s): Low TR is a predictor of all-cause mortality in patients with a pacemaker. Patients with TR >=94 % may experience lower incidences of mortality, and they should have a good prognosis. (Figure presented)