Impact of remote monitoring on ventricular arrhythmia management and mortality in ICD and CRT-D patients: insights from an ultraperipheral region
M Camara Farinha, I Barroso Almeida, I Coutinho Dos Santos, F Duarte, M I Barradas, A Monteiro, M PachecoAbstract
Background
Management of ventricular arrhythmias in heart failure (HF) patients living in geographically remote regions is challenging due to limited access to regular in-person follow-up, which can affect treatment patterns and clinical outcomes.
Objectives
To evaluate the impact of remote monitoring on the management of ventricular arrhythmias and mortality in heart failure (HF) with implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy defibrillator (CRT-D) devices followed in a geographically isolated healthcare setting.
Methods
We conducted a retrospective observational study including HF patients implanted with ICD or CRT-D devices at a single referral centre serving an ultra-peripheral archipelago (n=214). Patients were stratified according to the presence of remote monitoring. Endpoints included detection of ventricular tachycardia and/or ventricular fibrillation (VT/VF), delivery of anti-tachycardia pacing (ATP) appropriate shock therapy, all-cause mortality and cardiovascular mortality. Due to variable data completeness in this real-world registry, each endpoint was analysed using complete-case analysis.
Results
VT/VF episodes occurred at similar rates in patients with and without remote monitoring, with no statistically significant difference between the two groups (12.4% vs. 8.1%; odds ratio (OR) 1.61, p = 0.44). ATP delivery, assessed in 139 patients, was significantly higher in the remote monitoring group (11.5% vs. 1.6%; OR 7.83, p = 0.043). Appropriate shock rates, available for analysis in 144 patients, did not differ significantly between the two groups (9.5% vs. 6.7%; OR 1.47, p = 0.76), and no inappropriate shocks were recorded in either group. Cardiovascular mortality was significantly lower in the remote monitoring group (2.4% vs. 11.3%; p = 0.012), as was all-cause mortality (3.1% vs. 16.3%; p = 0.001).
Conclusions
In an ultra-peripheral island healthcare system, remote monitoring was associated with a shift in the management of ventricular arrhythmia towards ATP-based intervention, without an increase in shock therapy. This was accompanied by lower mortality rates among ICD and CRT-D recipients.