Remote monitoring of implantable defibrillators is associated with fewer inappropriate shocks and reduced time to medical assessment in a remote and rural area

Abstract

BACKGROUND Implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy with defibrillators (CRT-D) reduce mortality in certain cardiac patient populations. However, inappropriate shocks pose a problem, having both adverse physical and psychological effects on the patient. The advances in device technology now allow remote monitoring (RM) of devices to replace clinic follow up appointments. This allows real time data to be analysed and actioned and this may improve patient care. AIM To determine if RM in patients with an ICD is associated with fewer inappropriate shocks and reduced time to medical assessment. METHODS This was a single centre, retrospective observational study, involving 156 patients implanted with an ICD or CRT-D, followed up for 2 years post implant. Both appropriate and inappropriate shocks were recorded along with cause for inappropriate shocks and time to medical assessment. RESULTS RM was associated with fewer inappropriate shocks (13.6% clinic vs 3.9% RM; P = 0.030) and a reduced time to medical assessment (15.1 ± 6.8 vs 1.0 ± 0.0 d; P < 0.001). CONCLUSION RM in patients with an ICD is associated with improved patient outcomes.

Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy

“…Remote monitoring has been proven to reduce the rate of inappropriate shocks in adult implantable cardioverter-defibrillator patients. [146][147][148] Due to the early recognised and transmitted clues for lead failure by remote monitoring, the majority of lead failures is diagnosed before clinical complications such as inappropriate shocks occur. 149,150 Not surprisingly given the higher incidence of lead failure in children in comparison with adults, remote monitoring also improves the management of children with implantable cardioverter-defibrillators.…”

Remote Monitoring of CIEDs—For Both Safety, Economy and Convenience?

“…It has been shown that RM of ICDs reduces both the occurrence of inappropriate shocks and time to medical assessment when used in rural areas [ 20 ], and in a large Italian trial involving 1650 patients, RM was effective in detecting and managing clinical events with limited use of resources [ 21 ]. Thus, remote monitoring may detect changes of clinical importance and lead to changes in follow-up or medication.…”