Impact of remote monitoring on the management of arrhythmias in patients with implantable cardioverter-defibrillator

Marcantoni, Lina; Toselli, Tiziano; Urso, G.; Pratola, Claudio; Ceconi, Claudio; Bertini, Matteo

doi:10.2459/jcm.0000000000000148

Cited by 6 publications

(2 citation statements)

References 25 publications

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“…There were no significant differences between groups and subgroups with respect to cardiac decompensations or number of stored tachycardias. Similarly, a study by Marcantoni et al designed particularly to explore the effect of RM on supraventricular and ventricular arrhythmias also found no difference in incidence when comparing patients followed remotely to those followed in the clinic [ 19 ]. However, the study did report a reduction in associated events in the RM group, explained as due to the earlier detection and pre-emptive treatment of such arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

INvestigation on Routine Follow-up in CONgestive HearT FAilure Patients with Remotely Monitored Implanted Cardioverter Defibrillators SysTems (InContact)

Hansen

Loges

Seidl

et al. 2018

BMC Cardiovasc Disord

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BackgroundIn heart failure (HF) patients with implantable cardioverter defibrillators (ICD) or cardiac resynchronisation therapy defibrillators (CRT-D), remote monitoring has been shown to result in at least non-inferior outcomes relative to in-clinic visits. We aimed to provide further evidence for this effect, and to assess whether adding telephone follow-ups to remote follow-ups influenced outcomes.MethodsInContact was a prospective, randomised, multicentre study. Subjects receiving quarterly automated follow-up only (telemetry group) were compared to those receiving personal physician contact. Personal contact patients were further divided into those receiving automated follow-up plus a telephone call (remote+phone subgroup) or in-clinic visits only.ResultsTwo hundred and ten patients underwent randomisation (telemetry n = 102; personal contact n = 108 [remote+phone: n = 53; visit: n = 55]). Baseline characteristics were comparable between groups and subgroups. Over 12 months, 34.8% of patients experienced deterioration of their Packer Clinical Composite Response, with no significant difference between the telemetry group and personal care (p > 0.999), remote+phone (p = 0.937) or visit (p = 0.940) patients; predefined non-inferiority criteria were met. Mortality rates (5.2% overall) were comparable between groups and subgroups (p = 0.832/p = 0.645), as were HF-hospitalisation rates (11.0% overall; p = 0.605/p = 0.851). The proportion of patients requiring ≥1 unscheduled follow-up was nominally higher in telemetry and remote+phone groups (42.2 and 45.3%) compared to the visit group (29.1%). Overall, ≥ 1 ICD therapy was delivered to 15.2% of patients.ConclusionIn HF patients with ICDs/CRT-Ds, quarterly remote follow-up only over 12 months was non-inferior to regular personal contact. Addition of quarterly telephone follow-ups to remote monitoring does not appear to offer any clinical advantage.Trial registrationclinicaltrials.gov: NCT01200381 (retrospectively registered on September 13th 2010).

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Section: Discussionmentioning

confidence: 99%

INvestigation on Routine Follow-up in CONgestive HearT FAilure Patients with Remotely Monitored Implanted Cardioverter Defibrillators SysTems (InContact)

Hansen

Loges

Seidl

et al. 2018

BMC Cardiovasc Disord

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“…In the recently published analysis of an Israeli ICD Registry including 2349 consecutive cases, 13 the rate of appropriate ICD shocks among primary prevention patients was 2.6% at 30 months of follow-up. Although the rates of appropriate ICD therapy vary widely depending mainly on patient selection and device programming, 4 , 5 , 17 many patients are unlikely to benefit from ICD implantation. By contrast, many patients who are at risk of sudden arrhythmic death are not identified, because the largest population of sudden arrhythmic death patients exhibit only mildly depressed ejection fraction.…”

Section: Introductionmentioning

confidence: 99%

Improving the appropriateness of sudden arrhythmic death primary prevention by implantable cardioverter-defibrillator therapy in patients with low left ventricular ejection fraction. Point of view

Disertori

Gulizia

Casolo

et al. 2016

Journal of Cardiovascular Medicine

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It is generally accepted that the current guidelines for the primary prevention of sudden arrhythmic death, which are based on ejection fraction, do not allow the optimal selection of patients with low left ventricular ejection fraction of ischemic and nonischemic etiology for implantation of a cardioverter-defibrillator. Ejection fraction alone is limited in both sensitivity and specificity. An analysis of the risk of sudden arrhythmic death with a combination of multiple tests (ejection fraction associated with one or more arrhythmic risk markers) could partially compensate for these limitations. We propose a polyparametric approach for defining the risk of sudden arrhythmic death using ejection fraction in combination with other clinical and arrhythmic risk markers (i.e. late gadolinium enhancement cardiac magnetic resonance, T-wave alternans, programmed ventricular stimulation, autonomic tone, and genetic testing) that have been validated in nonrandomized trials. In this article, we examine these approaches to identify three subsets of patients who cannot be comprehensively assessed by the current guidelines: patients with ejection fraction of 35% or less and a relatively low risk of sudden arrhythmic death despite the ejection fraction value; patients with ejection fraction of 35% or less and high competitive risk of death due to evolution of heart failure or noncardiac causes; and patients with ejection fraction between 35 and 45% with relatively high risk of sudden arrhythmic death despite the ejection fraction value.

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Remote monitoring of implantable devices: Should we continue to ignore it?

Bertini

Marcantoni

Toselli

et al. 2016

International Journal of Cardiology

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Impact of remote monitoring on the management of arrhythmias in patients with implantable cardioverter-defibrillator

Abstract: Remote monitoring systems improved outcomes in patients with supraventricular arrhythmias by reducing the risk of cardiovascular events, but no benefits were observed in patients with ventricular arrhythmias.

Cited by 6 publications

References 25 publications

INvestigation on Routine Follow-up in CONgestive HearT FAilure Patients with Remotely Monitored Implanted Cardioverter Defibrillators SysTems (InContact)

INvestigation on Routine Follow-up in CONgestive HearT FAilure Patients with Remotely Monitored Implanted Cardioverter Defibrillators SysTems (InContact)

Improving the appropriateness of sudden arrhythmic death primary prevention by implantable cardioverter-defibrillator therapy in patients with low left ventricular ejection fraction. Point of view

Remote monitoring of implantable devices: Should we continue to ignore it?

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