Clinical characteristics of a real-world remote monitoring cohort of crt-d/icd recipients

Background

Remote monitoring (RM) of cardiac resynchronization therapy defibrillator (CRT-D) and implantable cardioverter-defibrillator (ICD) recipients enables continuous device-based surveillance, allowing early detection of arrhythmic events and physiological changes. Despite its growing adoption, the real-world clinical characteristics and outcomes of patients selected for RM remain incompletely characterized. This study aimed to describe the clinical profile, arrhythmic burden, and hard clinical endpoints observed in patients managed with RM.

Methods

We conducted a retrospective descriptive analysis of all patients with active RM included in a single-center institutional database. Demographic, etiological, functional, and comorbidity data were collected. Arrhythmic events were defined as any atrial or ventricular arrhythmia recorded by the device. Hard endpoints included heart failure (HF) hospitalizations, HF-related emergency department visits, HF-related inpatient admissions, and all-cause or cardiovascular mortality. Continuous variables are reported as median (interquartile range [IQR]) and categorical variables as proportions.

Results

A total of 34 patients undergoing RM were included. Median age at device implantation was 61 years (IQR 49.8–65.5), with a median age at baseline of 64 years (IQR 56–71). The majority were male (73.5%) and had ischemic cardiomyopathy (76.5%). Median left ventricular ejection fraction was 36% (IQR 30–47). The most prevalent comorbidities were dyslipidemia (82.3%), hypertension (58.8%), and diabetes mellitus (32.4%). Functional status was largely preserved, with 38.2% of patients in NYHA class I, 23.5% in class II, and 2.9% in class III.

During follow-up, two HF hospitalizations were recorded, and no all-cause or cardiovascular deaths occurred. RM revealed a substantial arrhythmic burden. Atrial arrhythmias, including paroxysmal atrial fibrillation or flutter, were detected in 20.5% of patients. Ventricular arrhythmias were also frequent, predominantly non-sustained ventricular tachycardia, occurring in 41.1% of patients. Mean device-measured physical activity was 3.9 ± 1.6 hours per day.

Conclusions

Patients managed with RM were predominantly younger, male individuals with ischemic cardiomyopathy, preserved functional status, and moderate left ventricular dysfunction. Although hard clinical endpoints were infrequent during follow-up, RM enabled the detection of a high burden of both atrial and ventricular arrhythmias, highlighting its role as a valuable diagnostic and early-warning tool. Future studies are warranted to determine whether early arrhythmia detection through RM translates into improved long-term clinical outcomes