Potential role of home monitoring to reduce inappropriate shocks in implantable cardioverter-defibrillator patients due to lead failure

Abstract

In 91% of all lead-related ICD complications, the diagnosis could be established correctly by an alert of the HM system. Mostly, the first incident sent was oversensing of artefacts, falsely detected as ventricular fibrillation-the VF zone. The automatic HM surveillance system enables physicians to detect severe lead problems early and to react quickly; thus, it might have a potential to avoid inappropriate shocks due to lead failure and T-wave oversensing.

Economic impact of remote monitoring on ordinary follow-up of implantable cardioverter defibrillators as compared with conventional in-hospital visits. A single-center prospective and randomized study

“…However, overall, the potential benefit of RM is important not only in terms of hospital and social costs but also in terms of other potential advantages deriving from early diagnosis of device-related events such as lead failure or T-wave oversensing [22], and clinical events such as AF [10,23] or heart failure [5,7,8,11,24,25]. Moreover, these adverse events detected by RM are often silent [5] and, in the case of AF, occurred in about 30 % of the patients as new onset AF [23].…”

“…Moreover, these adverse events detected by RM are often silent [5] and, in the case of AF, occurred in about 30 % of the patients as new onset AF [23]. Such early diagnosis may reduce the rate of hospitalization and/or length of in-hospital stay [11], decrease the incidence of strokes [26,27], and reduce the number of inappropriate shocks causing early depletion of ICD therapy [20,22]. Such clinical benefit may result in an additional and even more important reduction of overall healthcare resource consumption, making RM economically attractive.…”

Use of remote monitoring in the management of system-related complications in implantable defibrillator patients

“…Twenty system-related complications required surgical intervention (remote vs. conventional, 15 vs. 5). In a retrospective cohort analysis of patients with an ICD lead failure, remote monitoring resulted in a significant reduction of inappropriate shocks and symptomatic pacing inhibition compared with those without remote monitoring (27% vs. 53%, P00.04) [21].…”

“…For early detection of lead failure, continuous monitoring of sensing values and especially the detection of episodes caused by electrical oversensing would be more helpful. Spencker et al [21] found that up to 90% of the patients with lead failure presented with …”

Remote Monitoring of Patients With Implanted Cardiac Devices

“…Small retrospective studies have found that in patients with ICD lead failure, inappropriate shocks were experienced in only 27% of patients using remote monitoring compared to 53% of patients with traditional follow-up. 11,12 The investigators estimated that remote follow-up identified problems 54 days earlier than traditional follow-up.…”