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Alert notifications during automatic wireless remote monitoring of implantable cardioverter-defibrillators: Load, characteristics, and clinical utility

Published:November 29, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.11.019
      Alerts during automatic remote monitoring (RM) offer early event detection but risk data overload. Criteria for transmission vary and programming is inconsistent, reflecting lack of guidelines. What is unknown is a transmission schedule that captures important events but minimizes volume while maintaining patient safety. This was tested in the TRUST trial (the Lumos-T Reduces Routine Office Device Follow-Up Study; primary results reported previously
      • Varma N.
      • Epstein A.
      • Irimpen A.
      • et al.
      Efficacy and safety of automatic remote monitoring for ICD follow-up: the TRUST trial.
      ), which randomized follow-up (1:2) of 1450 patients (mean age 63 ± 13 years; 72% (1042/1450) male; New York Heart Association class I/II 67% (976/1450); left ventricular ejection fraction 29% ± 11%; coronary artery disease 67% (973/1450); 1° prevention indication 72% (1048/1450); DDD mode 57% (820/1450)) receiving implantable cardioverter-defibrillators to conventional care (evaluated in-office every 3 months) or to RM (Biotronik Home Monitoring) using a prespecified set of alert notifications with a high predictive value
      • Ricci R.
      • Morichelli L.
      • D’Onofrio A.
      • et al.
      Home monitoring manpower, sensitivity and positive predictive value of adverse event detection: preliminary results from the Home Guide registry.
      (Figure 1). Safety, a primary end point, was evaluated by the incidence of major adverse cardiovascular events including death, stroke, and cardiac surgical interventions. All patients gave written informed consent in this institutional review board–approved study conducted according to the Helsinki Declaration.
      Figure thumbnail gr1
      Figure 1Distribution of alert notifications received during automatic remote monitoring in the entire study cohort (left) and among only those patients transmitting at least 1 alert (right). RA = right atrial; RV = right ventricular; SVT = supraventricular tachycardia; VF = ventricular fibrillation; VT = ventricular tachycardia.

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