Key result
In patients with cardiac implantable electric devices followed by remote monitoring, the critical event rate was significantly higher in those with implantable cardioverter defibrillators compared to pacemakers (OR 7.895).
Why the study?
Although remote monitoring of CIEDs is standard, consensus statements still suggest annual face-to-face visits even without reported episodes; the study evaluated the actual critical event rate detected through remote monitoring.
What is the critical event rate detected by remote monitoring in patients with cardiac implantable electric devices?
Cohort (n=1,849)
Yes
What is the critical event rate detected by remote monitoring in patients with cardiac implantable electric devices?
Odds Ratio: 7.895 (95% CI 3.36–18.553)
Absolute Event Rate: 6.6% vs 0.9%
p-value: p=<0.0001
Remote monitoring of CIEDs reveals a high rate of abnormal events but a low rate of critical events, particularly in patients with pacemakers (<1%).
RM-derived critical event rates may inform CIED follow-up intervals; leaves open whether annual in-person visits can be safely reduced.
Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-to-face follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.
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Morimoto et al. (2019) conducted a cohort in Cardiac Implantable Electric Devices (CIEDs) (n=1,849). Implantable cardioverter defibrillator (ICD) vs. Pacemaker (PM) was evaluated on Critical events detected by remote monitoring (OR 7.895, 95% CI 3.360-18.553, p=<0.0001). In patients with cardiac implantable electric devices followed by remote monitoring, the critical event rate was significantly higher in those with implantable cardioverter defibrillators compared to pacemakers (OR 7.895).
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