Key result
Remote monitoring without a lead noise alert was associated with a 16-fold increase in the likelihood of initiating either a shock or ATP compared to monitoring with an alert (OR 16.0; 95% CI 1.8-143.3; P=0.01).
Why the study?
Does remote monitoring with a lead noise alert improve early detection of ICD lead failure and reduce inappropriate therapies in ICD patients compared to remote monitoring alone?
Cohort (n=1,224)
Does remote monitoring with a lead noise alert improve early detection of ICD lead failure and reduce inappropriate therapies in ICD patients compared to remote monitoring alone?
Absolute Event Rate: 77% vs 25%
p-value: p=0.002
Combining comprehensive remote monitoring with dedicated lead noise alerts significantly improves the early detection of pace-sense lead failures and reduces the likelihood of inappropriate ICD therapies.
May support lead noise alerts in remote ICD monitoring to reduce inappropriate therapies; leaves open need for randomized confirmation.
INTRODUCTION: Recognition of implantable cardioverter defibrillator (ICD) lead malfunction before occurrence of life threatening complications is crucial. We aimed to assess the effectiveness of remote monitoring associated or not with a lead noise alert for early detection of ICD lead failure. METHODS: From October 2013 to April 2017, a median of 1,224 (578-1,958) ICD patients were remotely monitored with comprehensive analysis of all transmitted materials. ICD lead failure and subsequent device interventions were prospectively collected in patients with (RMLN) and without (RM) a lead noise alert (Abbott Secure Sense™ or Medtronic Lead Integrity Alert™) in their remote monitoring system. RESULTS: During a follow-up of 4,457 patient years, 64 lead failures were diagnosed. Sixty-one (95%) of the diagnoses were made before any clinical complication occurred. Inappropriate shocks were delivered in only one patient of each group (3%), with an annual rate of 0.04%. All high voltage conductor failures were identified remotely by a dedicated impedance alert in 10 patients. Pace-sense component failures were correctly identified by a dedicated alert in 77% (17 of 22) of the RMLN group versus 25% (8 of 32) of the RM group (P = 0.002). The absence of a lead noise alert was associated with a 16-fold increase in the likelihood of initiating either a shock or ATP (OR: 16.0, 95% CI 1.8-143.3; P = 0.01). CONCLUSION: ICD remote monitoring with systematic review of all transmitted data is associated with a very low rate of inappropriate shocks related to lead failure. Dedicated noise alerts further reduce inappropriate detection of ventricular arrhythmias.
No takes yet. Share an insight, caveat, or question.
Ploux et al. (2018) conducted a cohort in ICD lead failure (n=1,224). Remote monitoring with a lead noise alert (RMLN) vs. Remote monitoring without a lead noise alert (RM) was evaluated on Correct identification of pace-sense component failures (p=0.002). Remote monitoring without a lead noise alert was associated with a 16-fold increase in the likelihood of initiating either a shock or ATP compared to monitoring with an alert (OR 16.0; 95% CI 1.8-143.3; P=0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: