Integrating digital health into the EP lab: feasibility, safety, and one-year outcomes of remote support for complex ventricular ablation procedures - results of the REMOTE-VA Study

Background

Catheter ablation (CA) is an established therapeutic option for selected patients with ventricular arrhythmias (VA) and is increasingly used in modern electrophysiology practice. Electroanatomical mapping (EAM) systems are typically operated on-site by field technical engineers (FTEs). Due to workforce limitations, FTEs often travel between hospitals, which reduces flexibility. Remote support (RS) for VA ablation procedures may help overcome these challenges by minimizing travel and improving resource efficiency.

Purpose

To compare the safety, feasibility, and one-year outcomes of remote versus on-site support for CA of VA.

Method

Consecutive patients who underwent ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation with RS were included (RS group). The control group consisted of an equal number of patients matched for procedure type who underwent ablations with on-site technical assistance. RS-guided three-dimensional (3D) mapping was performed by connecting the EAM system to an integrated audiovisual platform. High-definition cameras, headsets, and a stable internet connection enabled real-time communication between the operator and FTE, who worked exclusively remotely. Follow-up included hospital readmissions, unscheduled outpatient or emergency department (ED) visits within 30 days, and clinical assessments up to 12 months post-ablation.

Results

From October 2022 to January 2025, 60 patients underwent VT (36.7%) or PVC ablation using exclusively RS and were compared with 60 patients treated using on-site support. Demographic and procedural characteristics were similar between groups. No major technical issues or changes to on-site support were reported.

One (1.7%) intraprocedural complication occurred in the RS group versus four (6.7%) in the control group (p = 0.364). Overall, 23.3% of RS patients and 26.7% of control patients experienced complications by discharge. ED visits occurred in 8.3% of RS patients and 6.7% of controls, while 5% of patients in each group had unplanned outpatient visits. Post-procedural hospitalization was reported in 5% of RS patients and 10% of controls. RS procedures reduced CO2 emissions by 5.6 tons.

Follow-up data were available for 68.3% of RS patients and 75.0% of control patients (p = 0.418), with a median follow-up time of 364.0 (207.0–386.5) days and 357.0 (261.0–369.5) days, respectively (p = 0.489). Arrhythmia recurrence was documented in 15.0% of RS patients and 23.3% of control patients (p = 0.246), while re-ablation was performed in 5.0% and 6.7% of RS and control patients, respectively (p = 1.00). No complications directly related to the ablation procedure were reported.

Conclusion

To date, this is the largest study evaluating the feasibility, safety, and long-term outcomes of RS VA ablations. RS not only improves efficiency and flexibility in healthcare resource utilization but also contributes to environmental sustainability.