Early evaluation of atrial high rate episodes using remote monitoring in pacemaker patients: Results from the RAPID study

Abstract

Aim Remote monitoring (RM) of implantable cardiac devices has enabled continuous surveillance of atrial high rate episodes (AHREs) with well‐recognized clinical benefits. We aimed to add evidence on the role of the RM as compared to conventional follow‐up by investigating the interval from AHRE onset to physician’s evaluation and reaction time in actionable episodes. Methods and Results A total of 97 dual‐chamber pacemaker recipients were followed with RM (RM‐ON group; N = 64) or conventional in‐office visits (RM‐OFF group; N = 33) for 18 months. In‐office visits were scheduled at 1, 6, 12, and 18 months in the RM‐OFF group and at 1 and 18 months in the RM‐ON group. The overall AHRE rate was 1.98 per patient‐year (95% confidence interval [CI], 1.76–2.20) with no difference between the two groups (RM‐ON vs. RM‐OFF weighted‐HR, 0.88; CI, 0.36–2.13; p = .78). In the RM‐ON group, 100% AHREs evaluated within 11 days from onset, and within 202 days in the RM‐OFF group, with a median evaluation delay 79 days shorter in the RM‐ON group versus the RM‐OFF group (p < .0001). Therapy adjustment in actionable AHREs occurred 77 days earlier in the RM‐ON group versus the control group (p < .001). In the RM‐ON group, there were 50% less in‐office visits as compared to the RM‐OFF group (p < .001). Conclusions In our pacemaker population with no history of atrial fibrillation, RM allowed significant reduction of AHRE evaluation delay and prompted treatment of actionable episodes as compared to biannual in‐office visit schedule.

The incidence of atrial fibrillation, new oral anticoagulation, stroke, and significant bleeds in patients receiving a new dual-chamber pacemaker

“…In the prospective, non-interventional RAPID study the median evaluation delay for AHREs for the pacemaker patient group with remote monitoring on (RM-ON) was 79 days shorter than for the patient group with remote monitoring off (RM-OFF). In addition, therapy adjustments occurred 77 days earlier in the RM-ON group and there were 50 % less in-office visits compared to the RM-OFF group [8] . The randomized COMPAS trial showed similar results.…”

Implantable Loop Recorder with Long Sensing Vector: Safety, Acceptability, and Sensing Performance in Pediatric Patients

“…We suppose that it played an important role in the high sense of safety that resulted from our questionnaires. Despite clinical benefits, remote monitoring requires an increased work overload to physicians, nurses, and hospital stuff to check regularly automatic transmissions and to communicate with families during follow-up if symptoms occur or arrhythmias are detected [17][18][19]. More studies are required to better assess the impact of remote monitoring on the early detection of arrhythmias and the symptom-rhythm correlation in the pediatric population.…”

Remote monitoring of implantable cardiac monitors in patients with unexplained syncope: Predictors of false‐positive alert episodes

“…1 This approach safely reduces the burden of inoffice visits while ensuring early detection of arrhythmias and adverse events. 2 RM of implantable cardiac monitors (ICMs) in patients with unexplained syncope has been shown to facilitate the timely recognition of asymptomatic cardiac arrhythmias. [3][4][5] However, a significant challenge of this strategy may be the high volume of transmissions received by the device clinic, which requires resources for timely review.…”

“…Remote monitoring (RM) is recommended as part of the standard follow‐up management strategy for patients with cardiac implantable electronic devices 1 . This approach safely reduces the burden of in‐office visits while ensuring early detection of arrhythmias and adverse events 2 . RM of implantable cardiac monitors (ICMs) in patients with unexplained syncope has been shown to facilitate the timely recognition of asymptomatic cardiac arrhythmias 3–5 .…”