Remote monitoring (RM) of cardiac implanted electronic devices (CIED) is a technology established in the clinical practice, and should be offered as part of the usual care of patients. The RM accessibility, benefits and safety have been demonstrated in randomized clinical trials. However, data in daily clinical practice with unselected patients and including all manufacturers is limited.
The purpose of this study was to assess the impact of RM in the clinical practice. A detailed review of RM experience was performed in a tertiary referral hospital.
All patients with an CIED and RM followed-up in our center in 2017 were included. All manufacturers were included. Clinical and demographic characteristics were analyzed. The digital device data obtained in remote and in hospital follow-up visits were transferred in a system software package. Patients with ICD were seen annually with in clinic device interrogation, patients with CRT were seen every six months. All patients were scheduled for a RM transmission every four months. The total number of scheduled and unscheduled in hospital visits was analyzed. The amount of remote visits that represented clinically significant conditions was evaluated. A protocol of classification by colors is used in our center: green (non clinical relevance), yellow (mild clinical - electrical instability), red (critical clinical - electrical instability, ERI).
A total of 860 patients are in RM (64% ICD, 30% CRT-D, 6% CRT-P, 78.2% males, 65 ± 12.93 years, 65.96% primary prevention). The number of in hospital follow-up was 1.69 visits /patient /year. A total of 2968 transmissions were received and analyzed during the study period (3.45 transmissions /patient / year). Of this total 273 (9.2%) transmissions were unscheduled (alert, event, duplicate or unintentional). A 21.44% of RM transmissions were classified as yellow or red, according our local protocol. A 4.94% of the transmissions induced an unscheduled in hospital visit to reprogramming or initiation / uptritaion medication, of which 10 cases were due to asymptomatic new onset atrial fibrillation.
RM allows a reduction in hospital follow-up visits, generates a very low proportion of unscheduled visits, and allows early detection of asymptomatic events.