Key result
S-ICD remote monitoring generates high unactionable burden with only ~3% of transmissions prompting clinical action.
Why the study?
Remote monitoring provides potential benefits in transvenous ICDs, but its potential value had not been evaluated in subcutaneous-ICD recipients.
Does remote monitoring in S-ICD recipients provide clinically relevant alerts without excessive unactionable burden?
Cohort (n=69)
No
Does remote monitoring in S-ICD recipients provide clinically relevant alerts without excessive unactionable burden?
Answers are grounded in this paper and cite their sources.
Remote monitoring in S-ICD patients detects relevant clinical events but generates a high burden of unactionable, mostly patient-initiated transmissions.
INTRODUCTION: Several clinical studies have demonstrated that remote monitoring (RM) offers potential benefits in transvenous implantable cardioverter defibrillator (ICD). The potential interest of RM in subcutaneous-ICD (S-ICD) recipients has never been evaluated. The aim of this study was to evaluate the alert burden and its clinical relevance in a prospective cohort of S-ICD recipients. METHODS: We prospectively and consecutively enrolled all patients undergoing S-ICD implantation at Lille University Hospital from September 2015 to January 2017 and gave them a LATITUDE™ NXT RM system. The relevance of transmissions was assessed by the following ratio: number of transmissions leading to reaction or intervention per patient/number of transmissions per patient. RESULTS: From September 2015 to January 2017, 69 patients were enrolled with a mean follow-up of 415 ± 96.3 days. The mean age was 44.6 ± 15.6 years old, and 25% (n = 17) had ischemic cardiomyopathy. At the end of follow-up, 12% of the patients had events recorded by RM. These events were related to nine ICD shocks and eight untreated events. A total of 1,423 transmissions were collected. Most of these transmissions were patient-initiated without any event (77%, n = 1,096) or scheduled without any event (19%, n = 272). Only 3.2% ± 1.1 of the transmissions per patient led to reactions or interventions. CONCLUSION: On the basis of the current method of transmitting, S-ICD RM allowed detection of relevant events in 12% of patients but generated a high unactionable transmission burden. As a result of these findings, efforts should be made to optimize transmissions considering automatic transmissions and to focus on patient education.
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Ninni et al. (2019) conducted a cohort in Subcutaneous implantable cardioverter defibrillator (S-ICD) recipients (n=69). Remote monitoring (LATITUDE™ NXT RM system) was evaluated on Relevance of transmissions (ratio of transmissions leading to reaction or intervention per patient to total transmissions per patient). Remote monitoring in S-ICD recipients detected relevant events in 12% of patients but generated a high unactionable burden, with only 3.2% of transmissions leading to clinical action.
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