Ninni Sandro, Delahaye Camille, Klein Cédric, Marquie Christelle, Klug Didier, Lacroix Dominique, Brigadeau François, Potelle Charlotte, Kouakam Claude, Finat Loïc, Guedon-Moreau Laurence
CHRU Lille, Institut Cœur-Poumon - Bd du Professeur Jules Leclercq - CHU Lille, F59037-Lille, France.
Institut Pasteur de Lille, UMR1011, F59000-Lille, France.
Pacing Clin Electrophysiol. 2019 Mar;42(3):349-355. doi: 10.1111/pace.13598. Epub 2019 Jan 15.
Several clinical studies have demonstrated that remote monitoring (RM) offers potential benefits in transvenous implantable cardioverter defibrillator (ICD). The potential interest of RM in subcutaneous-ICD (S-ICD) recipients has never been evaluated. The aim of this study was to evaluate the alert burden and its clinical relevance in a prospective cohort of S-ICD recipients.
We prospectively and consecutively enrolled all patients undergoing S-ICD implantation at Lille University Hospital from September 2015 to January 2017 and gave them a LATITUDE™ NXT RM system. The relevance of transmissions was assessed by the following ratio: number of transmissions leading to reaction or intervention per patient/number of transmissions per patient.
From September 2015 to January 2017, 69 patients were enrolled with a mean follow-up of 415 ± 96.3 days. The mean age was 44.6 ± 15.6 years old, and 25% (n = 17) had ischemic cardiomyopathy. At the end of follow-up, 12% of the patients had events recorded by RM. These events were related to nine ICD shocks and eight untreated events. A total of 1,423 transmissions were collected. Most of these transmissions were patient-initiated without any event (77%, n = 1,096) or scheduled without any event (19%, n = 272). Only 3.2% ± 1.1 of the transmissions per patient led to reactions or interventions.
On the basis of the current method of transmitting, S-ICD RM allowed detection of relevant events in 12% of patients but generated a high unactionable transmission burden. As a result of these findings, efforts should be made to optimize transmissions considering automatic transmissions and to focus on patient education.
多项临床研究表明，远程监测（RM）在经静脉植入式心律转复除颤器（ICD）中具有潜在益处。RM在皮下植入式心律转复除颤器（S-ICD）接受者中的潜在价值从未得到评估。本研究的目的是评估S-ICD接受者前瞻性队列中的警报负担及其临床相关性。
我们前瞻性地连续纳入了2015年9月至2017年1月在里尔大学医院接受S-ICD植入的所有患者，并为他们提供了LATITUDE™ NXT RM系统。通过以下比率评估传输的相关性：每位患者导致反应或干预的传输次数/每位患者的传输次数。
2015年9月至2017年1月，共纳入69例患者，平均随访415±96.3天。平均年龄为44.6±15.6岁，25%（n = 17）患有缺血性心肌病。随访结束时，12%的患者有RM记录的事件。这些事件与9次ICD电击和8次未处理事件有关。共收集到1423次传输。这些传输大多是患者主动发起且无任何事件（77%，n = 1096）或按计划进行且无任何事件（19%，n = 272）。每位患者只有3.2%±1.1的传输导致反应或干预。
基于当前的传输方法，S-ICD RM能在12%的患者中检测到相关事件，但产生了高比例的无实际作用的传输负担。基于这些发现，应努力优化传输，考虑自动传输，并注重患者教育。
