Key result
Remote monitoring fails to reduce time to first arrhythmia detection versus standard care in pacemaker recipients.
Why the study?
Recommendations for CIED remote monitoring are primarily based on ICD studies, and evidence was needed to reinforce this recommendation for pacemaker recipients.
Does remote monitoring reduce the time to detection of the first arrhythmic event in pacemaker recipients with increased stroke risk?
Cohort (n=203)
No
Does remote monitoring reduce the time to detection of the first arrhythmic event in pacemaker recipients with increased stroke risk?
In pacemaker recipients with elevated stroke risk, remote monitoring did not significantly reduce the time to detection of the first arrhythmic event compared to standard care, though it demonstrated high acceptance.
Remote monitoring was not associated with earlier arrhythmic detection in elderly pacemaker recipients; leaves open its utility and requires randomized confirmation.
INTRODUCTION: Current expert consensus recommends remote monitoring (RM) for cardiac implantable electronic devices (CIEDs). As this recommendation is primarily based on studies involving implantable cardioverter defibrillators (ICDs), the HERO (HEart Rhythm management Optimisation of pacemaker recipients using remote monitoring) study aimed to reinforce this recommendation for pacemaker recipients. Occurrence and detection time of atrial and ventricular arrhythmias were analysed in patients with RM (RM+; n = 60) and those without RM (RM-; n = 143), together with CIED adverse events, cardiology visits and anticoagulation adjustments. RESULTS: The median age of the patients was 80 (73-85) years, with 55.2% being men. During a median follow-up of 5.0 years, 53.7% were diagnosed with at least one arrhythmic event (RM+ 60.0% vs RM- 51.0%, p = 0.28). The median time from pacemaker implantation to detection of first arrhythmic event was 2.5 (0.5-8.2) years in the RM+ group versus 2.8 (1.2-8.0) years in the RM- group (hazard ratio 0.89; 95% confidence interval 0.59-1.35; p = 0.58). There were no differences in the number of adverse events or anticoagulation adjustments during follow-up. More CIED telephone consultations were conducted in the RM+ group. CONCLUSION: A substantial proportion of pacemaker patients experienced one or more arrhythmic events during follow-up. The HERO study did not demonstrate a difference in time to detection of the first event when using remote monitoring.
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Adriaansen et al. (2025) conducted a cohort in Pacemaker recipients with increased stroke risk (n=203). Remote monitoring vs. No remote monitoring was evaluated on Time from pacemaker implantation to detection of the first arrhythmic event (HR 0.89, 95% CI 0.59-1.35, p=0.58). Remote monitoring did not significantly reduce the time to detection of the first arrhythmic event compared to no remote monitoring in pacemaker recipients (HR 0.89).
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