Remote monitoring temporal trends during COVID-19 pneumonia in patients with implanted defibrillators

Abstract

It is unknown whether some of the clinical parameters transmitted by remote monitoring (RM) of cardiac implanted devices could show recurrent patterns caused by COVID-19 infection. Our aim was to describe RM daily temporal trends for implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) recipients during COVID-19 infection. A 65-year-old woman with a CRT-D had a sudden increase of approximately 15 bpm and 10 bpm in nocturnal and mean heart rate, respectively, 11 days before hospitalization for COVID-19 pneumonia. At the same time physical activity decreased progressively and continuously. A 78-year-old woman with an ICD showed significant changes in RM trends starting from the COVID-19-related symptoms: strong decrease in physical activity, progressive increase in mean and nocturnal heart rate, irregular trend of heart rate variability, and rapid drop in thoracic impedance. Two months later, on hospitalization, computed tomography showed a "crazy-paving" pattern of the lungs, which is a clinical picture of COVID-19 pneumonia with concomitant pleural effusion. <Learning objective: Patients with complications related to the COVID-19 infection appeared to show variations in the remote monitoring (RM) temporal trends of clinical variables daily transmitted from implanted cardiac devices. These changes may not be specific to COVID-19, but owing to the severity of the pandemic, the use of RM to capture patient's condition makes intuitive sense for early diagnosis, intervention, and additional follow-up in this high-risk population.>.

Keywords: COVID-19; Cardiac resynchronization therapy; Implantable cardioverter defibrillator; Remote monitoring; SARS-CoV.

Fig. 1

(A) Chest computed tomography images at hospital admission of case 1. (B) Chest computed tomography images at hospital admission of case 2. The red arrows point to the “crazy-paving” pattern of the lungs, which is a clinical picture of SARS-CoV-2 pneumonia.

Fig. 2

Remote monitoring temporal trends during COVID-19 infection for case 1. Red dashed line represents the day of emergency room admission, while missing transmissions covered the period of hospital stay. Graph represents daily values.

Fig. 3

Six-month remote monitoring temporal trends of case 2. Red dashed line represents the day of emergency room admission, while missing transmissions covered the period of hospital stay. Graph represents mean values per week with standard deviation.