Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Monitoring & Follow-up D-PO05 - Poster Session V (ID 39) Poster

D-PO05-088 - Remote Monitoring Of Implantable Cardioverter Defibrillators: An Analysis Of >3000 Alert Episodes (ID 541)

Abstract

Background: Remote monitoring (RM) has been demonstrated to improve outcomes and mortality in patients with implantable cardioverter defibrillators (ICD) with and without cardiac resynchronisation therapy (CRT-D). However, the RM burden associated with monitoring ICDs is not well characterised and has implications for service delivery.
Objective: To assess ICD alert burden and type in a large cohort of patients receiving RM.
Methods: We analysed a multi-centre cohort of patients with a cardiac implantable electronic device (CIED) in situ, undergoing RM via PaceMateTM Live over a six-month time period (May to November 2018). Analysis included all ICD alerts according to type and gravity (red= requiring urgent review, yellow= non-urgent review), relative to the remainder of the CIED cohort.
Results: Of the 12,521 RM patients in our cohort, 4385 (35%) had an ICD in situ. There were 2202 ICDs (50.2% of the ICD cohort), 2079 (47.4%) CRT-Ds, and 104 (2.4%) S-ICDs. 1477 ICDs (33.7% of the ICD cohort) transmitted at least one alert. Of a total 17,839 alerts in the cohort, ICDs were responsible for 17.4% (3110) of all alerts, transmitting 399 (58.3% of all) red alerts, and 2711 (15.8% of all) yellow alerts. 988 alerts for ventricular tachycardia (VT) and ventricular fibrillation (VF) were transmitted by 7% (306) of ICD patients. 1.3% (57) of patients had more than one VT or VF alert. There were 212 alerts for shock, transmitted by 2.6% (115) of ICD patients, 28.7% (33) of whom had multiple shock alerts. There were 1403 alerts for atrial tachycardia/atrial fibrillation (AT/AF; 45% of all ICD alerts.
Conclusion: In this large cohort of patients undergoing RM, ICDs transmitted the majority (58.3%) of red alerts, while 45% of ICD alerts were attributable to AT/AF. The burden of alerts, especially those for AF, in this patient population highlights the need for individualised alert programming, as well as the need for infrastructure to process and appropriately respond to alert episodes.
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