Analysis of remote monitoring of patients with subcutaneous defibrillator

2019 
Introduction Remote monitoring is associated with a high level of evidence in endovascular ICD recipients. Subcutaneous cardioverter are more and more used but there is no data about remote monitoring for these devices. The aim of this study is to provide a qualitative and quantitative analysis of transmissions received by remote monitoring follow-up on a cohort of patients with subcutaneous ICD versus a control cohort of patients with endovascular ICD, and to evaluate the clinical relevance of these transmissions. Method From September 2015 to January 2017, we prospectively and consecutively enrolled all patients undergoing a subcutaneous or endovascular ICD implantation. All transmissions from remote follow-up and reactions to these transmissions were collected. The relevance of alerts was evaluated by a ratio: number of alerts per patient/number of alerts leading to a reaction or intervention. Results A total of 146 patients were included: 69 in the subcutaneous DAI group (44,6 ± 15.6 years old; 25% ischemic cardiopathy), 77 in the endovascular ICD group (64,8 ± 13.9 years old; 77% ischemic cardiopathy) with a mean follow-up of 493 ± 129.6 days. A total of 2393 transmissions were collected including 988 in the endovascular group (41%) and 1405 in the S-ICD group (59%). Twenty-nine internal electrical shocks were collected: 10 in the intravenous ICD cohort and 9 in the subcutaneous ICD patients. The clinical relevance of these transmissions was lower in the subcutaneous group with only 2% of transmissions leading to a medical intervention compared to 14% in the endovascular group ( P P  = 0.0391). Conclusion Remote monitoring of patients with subcutaneous ICD is associated with a higher burden of transmissions with a lower clinical impact compared to patients with endovascular ICDs.
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