Remote Monitoring Transmissions
Number and type of clinically relevant RM transmissions in the overall RM population are summarized in Table 3. Among new RM patients enrolled, 4365 clinically relevant RM transmissions were registered: no significative differences in number and type of transmissions were reported between Group hdRM and Group odRM (13.4 vs 13.2 transmissions/patient; p=0.18; Table 4).
Some critical alerts were recorded. Specifically, a syntomatic sinus pause (average pause length: 5.1 ± 1.7 seconds) was found in 12 patients with ILR: in 8 (66.7%) a PMK was implanted, while in the other 4 (33.3%) beta-blockers and/or amiodarone was discontinued, avoiding IPEs. Ten ILR patients (1%) were diagnosed with sustained episodes of supraventricular tachycardia (SVT), 3 (30%) of whom referring pre-syncopal or syncopal symptoms and requiring an electrophysiological study and radiofrequency catheter ablation. Newly diagnosed AF was reported in 26 (2.6%) patients: 22 (84.6%) were contacted by phone and prescribed with long-term oral anticoagulation according to their CHA2DS2VASc score. Episodes of sustained VT appropriately treated by the ICD were reported in 3 patients (0.3%): in two (66.7%) cases amiodarone was added whereas catheter ablation was performed in one (33.3%). Increased lead impedance without threshold or sensing changes was reported in 4 (0.4%) patients.
Acute HF decompensation was suspected in 25 (2.5%) patients via the OptiVol Alert (Medtronic) or HeartLogic (Boston) indexes: 10 (40%) patients were managed trans-telephonically via loop diuretic titration, 7 (28%) required hospitalization, and 8 (32%) were scheduled for an IPE to optimize the pharmacological therapy.