56-42: Characteristics of VF episodes in ICD patients transmitted by a new remote monitoring system – First results of the German CareLink Analytics Device Database

Abstract

and 18 Policlinico S.Orsola-Malpighi, Bologna, ItalyPurpose of the study: Intensified follow up schedule is required when approaching implantable-cardioverter defibrillator (ICD) elective replacement indicator (ERI). Remote monitoring (RM) may replace in person visits at the end of battery life and enable prompt medical decisions. We studied the use of RM in the management of ICD end-of-life in current clinical practice. Method used: 801 consecutive patients from the DECODE registry who underwent an ICD replacement for battery depletion from March 2013 to November 2014 in 36 Italian centers were included in this analysis. In addition to baseline clinical characteristics, following data from replaced devices were collected: battery status, overall percentage of pacing, total number of shocks delivered, pacing outputs, frequency of in person visits, and ERI-to-replacement time period. Summary of results: Among replaced devices, 403 were single-or dual-chamber ICDs and 398 CRT-Ds. Mean service life was 2050 + 514 days. RM was adopted in 73 patients while the remaining 728 were followed-up through standard in person visits. During the last year before replacement, visits were scheduled every 6 months [95%CI: 4-6] for patients using RM and every 3 months [3][4] for the remaining patients ( p , 0.001), the last visit was performed 48 days before replacement in RM group and 30 days [30][31][32][33][34][35] in the other ( p ¼ 0.002). On multivariate analysis only RPM was independently associated with a frequency of less than 1 visit every 3 months (OR 2.58, 95%CI 1.46 to 4.53; p ¼ 0.001). 551 (70%) devices were replaced in ERI status and the information about ERI-to-replacement time was available in 453 patients. The median ERI-to-replacement time was 33 days [28][29][30][31][32][33][34][35][36][37][38][39][40], while it exceeded the recommended safety period of 90 days in 51 (11%) of cases. In 8 (16%) of them (all cases non-equipped with RM), the last ICD interrogations was performed before ERI was triggered. Conclusion:The RM allowed to reduce the frequency of scheduled visits in the ICD end-of-life phase. In the clinical practice the recommended safety period for replacement is sometimes exceeded, and in patients non-equipped with RM this potentially unsafe status may remain undetected. Introduction: ICD-and CRT-D systems offer a broad variety of ventricular arrhythmia (VA) detection settings. In Germany, only few information is available for patients ( pts) using remote monitoring to transmit the device information. Therefore, the current investigation observes the characteristics of such VAs in the VF zone using an almost nationwide database. Methods: For this analysis, follow-up data of Medtronic ICD and CRT-D have been analyzed by Advanced Analytics. Advance Analytics is a SQL database that allows the collection of follow-up from Medtronic's 2090 programmer as well as CareLink transmissions from followup centers. Data was collected from 07/2004 to 11/2015. In this investigation, the characteristics of stored epi...