A low critical event rate despite a high abnormal event rate in patients with cardiac implantable electric devices followed up by remote monitoring

Yoshimasa Morimoto, Nobuhiro Nishii, Saori Tsukuda, Satoshi Kawada, Masakazu Miyamoto, Akihito Miyoshi, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Research output: Contribution to journalArticle

Abstract

Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-toface follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.

Original languageEnglish
Pages (from-to)2333-2340
Number of pages8
JournalInternal Medicine
Volume58
Issue number16
DOIs
Publication statusPublished - Jan 1 2019

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Implantable Defibrillators
Equipment and Supplies
Arrhythmogenic Right Ventricular Dysplasia
Brugada Syndrome
Cardiac Resynchronization Therapy
Defibrillators
Hypertrophic Cardiomyopathy
Ambulatory Care Facilities
Cohort Studies
Referral and Consultation
Multivariate Analysis
Retrospective Studies
Delivery of Health Care

Keywords

  • Cardiac resynchronization therapy with defibrillator
  • Implantable cardioverter defibrillator
  • Pacemaker
  • Remote monitoring

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{57c6af96f64c410d815042c2021a1a6d,
title = "A low critical event rate despite a high abnormal event rate in patients with cardiac implantable electric devices followed up by remote monitoring",
abstract = "Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-toface follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7{\%}) were abnormal events and only 676 (4.1{\%}) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9{\%} vs. 5.0{\%} or 5.9{\%}, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1{\%} in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.",
keywords = "Cardiac resynchronization therapy with defibrillator, Implantable cardioverter defibrillator, Pacemaker, Remote monitoring",
author = "Yoshimasa Morimoto and Nobuhiro Nishii and Saori Tsukuda and Satoshi Kawada and Masakazu Miyamoto and Akihito Miyoshi and Koji Nakagawa and Atsuyuki Watanabe and Kazufumi Nakamura and Hiroshi Morita and Hiroshi Ito",
year = "2019",
month = "1",
day = "1",
doi = "10.2169/internalmedicine.1905-18",
language = "English",
volume = "58",
pages = "2333--2340",
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TY - JOUR

T1 - A low critical event rate despite a high abnormal event rate in patients with cardiac implantable electric devices followed up by remote monitoring

AU - Morimoto, Yoshimasa

AU - Nishii, Nobuhiro

AU - Tsukuda, Saori

AU - Kawada, Satoshi

AU - Miyamoto, Masakazu

AU - Miyoshi, Akihito

AU - Nakagawa, Koji

AU - Watanabe, Atsuyuki

AU - Nakamura, Kazufumi

AU - Morita, Hiroshi

AU - Ito, Hiroshi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-toface follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.

AB - Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-toface follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.

KW - Cardiac resynchronization therapy with defibrillator

KW - Implantable cardioverter defibrillator

KW - Pacemaker

KW - Remote monitoring

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U2 - 10.2169/internalmedicine.1905-18

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