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. 2018 Nov 4:2018:3120480.
doi: 10.1155/2018/3120480. eCollection 2018.

Clinical Course of Dual-Chamber Implantable Cardioverter-Defibrillator Recipients followed by Cardiac Remote Monitoring: Insights from the LION Registry

Joerg O Schwab  1 , Herbert Nägele  2 , Hanno Oswald  3 , Gunnar Klein  3 , Oliver Gunkel  4 , Andreas Lang  5 , Wolfgang R Bauer  6 , Paul Korb  7 , Tino Hauser  7
Affiliations

Clinical Course of Dual-Chamber Implantable Cardioverter-Defibrillator Recipients followed by Cardiac Remote Monitoring: Insights from the LION Registry

Joerg O Schwab et al. Biomed Res Int. .

Abstract

Patients receiving dual-chamber implantable cardioverter-defibrillator (DR-ICD) therapy are at risk of developing atrial arrhythmia because of the increased rate of ventricular pacing and the progression of heart failure. Remote monitoring (RM) may identify the patients at highest risk of adverse events such as atrial arrhythmias. A total of 283 patients with 91,632 remote transmissions during a 15-month follow-up (FU) period enrolled in the LION registry were analysed. The parameters retrieved included the pacing mode, lower rate limit, percentage of atrial (%AP) and ventricular pacing (%VP), and percentage of atrial arrhythmia burden (%AB). In 92.7% of patients, the devices were initially programmed in DDD(R) or DDI(R), with changes of the pacing mode in 19.3% only. The lower rate limit remained stable in 80.4% of patients. At the first transmission, 8.7% of patients suffered from RM-detected atrial arrhythmia, which reached 36% during FU. The %AP was not associated with increased AB (p = 0.67), but the %VP was different in patients developing RM-detected atrial arrhythmia (26.9% vs. 13.7%, p < 0.00001). The %VP increased in 105 patients (significance level of α = 0.05), and 11 patients crossed the border of 50% VP. The LION substudy supports the concept of using RM in a real-world DR-ICD population. Remote monitoring of DR-ICDs allows for the quantification of the course of the pacing parameters and AB. Based on these observations, device parameters can be adjusted and optimized.

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Figures

Figure 1
Figure 1
Monthly prevalence of the mean percentage of atrial pacing during follow-up.
Figure 2
Figure 2
Monthly prevalence of the mean percentage of ventricular pacing during follow-up.
Figure 3
Figure 3
Mean percentage of ventricular pacing during follow-up.
Figure 4
Figure 4
Association between the atrial arrhythmia burden, the percentage of atrial pacing, and the percentage of ventricular pacing. The comparisons are based on the mean %AP and %VP values over the entire follow-up period (the mean values are based on all available remote data transmissions of all patients in the respective AB group). Group AB = 0 includes patients who never had a transmitted AB value > 0 over the follow-up period. Group AB > 0 includes patients who had a least one AB value > 0 over the follow-up period.
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