Remote monitoring of pacemakers and defibrillators: Effective and safe in Brazil?

Abstract

Background: The remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has become a common method of in-home monitoring and follow-up in high-income countries given its effectiveness, safety, convenience, and the possibility of early intervention. However, in Brazil, RM is still underutilized.

Objectives: This observational study aims to demonstrate our experience of using RM in Brazil and the predictive factors of RM of CIED follow-up in Brazil.

Methods: This was a prospective cohort study of patients with a CIED. Event rates are reported and clinical responses to those findings and outcomes based on the detection of RM. A logistic regression model was performed to identify predictors of more events, with P < .05 for statistical significance.

Results: This study evaluated consecutive 119 patients: 30.2% with pacemakers, 42.8% with implantable cardioverter-defibrillator, 22.7% with cardiac resynchronization therapy (CRT) with defibrillator, and 3.3% with CRT with pacemaker. Events were detected in 63.9% of the cases in 29.5 ± 23 months of follow-up. The outcomes found were that 44.5% needed elective evaluation in medical treatment and 23.5% needed immediate evaluation in therapy. Logistic regression analysis showed that the groups with CRT or CRT with defibrillator (75.0%), reduced ejection fraction (76.5%), and New York Heart Association functional class ≥II (75.0%) had the highest RM event rates.

Conclusions: RM proved to be effective and safe in the follow-up of patients with CIEDs in Brazil, allowing early interventions and facilitating therapeutic management.

Keywords: Brazil; Implantable cardioverter-defibrillator; Middle-income countries; Pacemaker; Remote monitoring.

Figure 1

A: Elective therapy evaluation with remote monitoring. EBD indicates that the electrode or battery includes ventricular sensing amplitude 2 mV, atrial sensing amplitude <0.5 mV, and elective replacement time; PL indicates biventricular pacing <85%; and TIC indicates changes in mean thoracic impedance over the last 13 days (as determined by the manufacturer). B: Immediate therapy evaluation with remote monitoring. Therapies include atrial tachycardia (AT) pacing therapy and shocks; shocks include appropriate and inappropriate shocks of implantable cardioverter-defibrillator. EBD indicates that the electrode and battery include implantable cardioverter-defibrillator therapy disable, reset mode, end-of-life battery, and change in impedance shocks. AT and AF refer to a patient experiencing >130 beats/min more than 10% of the day (as determined by the manufacturer). AF = atrial fibrillation; HARE = high atrial rate episodes; NSVT = nonsustained ventricular tachycardia; SVT = sustained ventricular tachycardia.

Figure 2

This patient had inappropriate shock during the electroacupuncture session, causing noise on the atrial and ventricular channels, when inadvertently used. This resulted in a remote monitoring alert.