Unscheduled Remote Monitoring Transmissions From Patients With Cardiac Implantable Electronic Devices and Management Changes: An Analysis of Patients Attending a Dedicated Devices Clinic Within an Advanced Heart Failure Service

Introduction: Remote monitoring of cardiac implantable electronic devices (CIEDs) reduces morbidity and mortality and is guideline recommended. The increasing number of patients with CIEDs and volume of transmissions creates significant workload. We sought to describe the burden of unscheduled transmissions and resulting management changes in an advanced heart failure service. Methods: This was a retrospective single-centre study of transmissions during 2023 from patients with CIEDs attending a dedicated devices clinic within the Western Australian Advanced Heart Failure and Cardiac Transplant Service. Transmissions were evaluated by a certified device specialist and management changes were made with cardiologists. Results: Of 5187 transmissions from 311 patients [age 56.4±13.2 years, 226 (72.7%) males], 2723 (52.5%) were unscheduled from 259 (83.3%) patients. Of these 259 patients, 10 (3.9%) had pacemakers, 133 (51.4%) implantable cardioverter defibrillators (ICD), 7 (2.7%) and 101 (39.0%) cardiac resynchronisation therapy (CRT) with pacemakers or ICDs respectively, and 8 (3.1%) loop recorders. Unscheduled transmissions included ventricular tachycardia/fibrillation (n=28; 1.0%), non-sustained ventricular tachycardia (n=355; 13.0%), atrial fibrillation/supraventricular tachycardia (n=868, 35.8%), lead issues (n=454; 16.7%), suboptimal CRT pacing (n=132; 4.8%), thoracic impedance (n=238; 8.7%), patient-initiated (n=468; 16.6%) and others (n=180; 6.6%). Unscheduled transmissions led to 54 (2.0%) patient encounters, resulting in 2 (0.1%) hospital admissions, 18 (0.7%) programming changes and 26 (1.0%) medication changes [19 (73.1%) were for ventricular arrhythmias]. Conclusions: Remote monitoring in our cohort generated a large workload but allowed for timely detection and management of ventricular arrhythmias. This has implications on resource allocation, workflow models and personalising device transmission settings.