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