Bertini Matteo, D'Onofrio Antonio, Piacenti Marcello, Lavalle Carlo, La Greca Carmelo, Amellone Claudia, Compagnucci Paolo, Calò Leonardo, Rapacciuolo Antonio, Santobuono Vincenzo Ezio, Pepi Patrizia, Savarese Gianluca, Taravelli Erika, Russo Vincenzo, Vitulano Gennaro, Villella Francesco, Vitali Francesco, Pierucci Nicola, Campari Monica, Valsecchi Sergio, Santini Luca
Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy.
Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, Naples, Italy.
Heart Rhythm O2. 2024 Dec 4;6(3):246-252. doi: 10.1016/j.hroo.2024.11.024. eCollection 2025 Mar.
The recently published Consensus Statement on the Practical Management of Remote Device Clinics offers recommendations for managing patients with cardiovascular implantable electronic devices (CIEDs). They recommend activating remote monitoring (RM) soon after implantation and maintaining connectivity. Moreover, it is reasonable to replace scheduled device follow-up with alert-based RM, with alert parameters customized to clinical indications to reduce RM workload.
The purpose of this study was to evaluate current clinical practice to inform adjustments to better follow recommendations and improve use of RM.
Data from 6553 CIED patients followed on the LATITUDE (Boston Scientific) remote network at 26 centers between 2010 and 2023 were analyzed. Median RM duration was 40 months.
Patient enrollment significantly increased over the observation period. The proportion of patients enrolled within 2 weeks of implantation was 73% and within 3 months was 94%. At the time of data extraction, 14% of patients had interrupted connectivity. Scheduled device transmissions were programmed at least once every 3 months in 96% of patients for all CIED types. In 2023, 6600 in-office interrogations were performed, and 70,453 remote transmissions were reviewed. Scheduled transmissions accounted for 52% of the total, patient-initiated interrogations for 28% and alert transmissions for 20%.
The use of RM in clinical practice is increasing, with more in-office and remote visits. Centers are not adopting the alert-based RM strategy, which would enable them to reduce the significant burden of nonactionable remote and in-office visits.
最近发布的《远程设备诊所实际管理共识声明》为管理心血管植入式电子设备（CIED）患者提供了建议。他们建议在植入后尽快启动远程监测（RM）并保持连接。此外，用基于警报的RM取代定期设备随访是合理的，警报参数根据临床指征定制，以减少RM工作量。
本研究的目的是评估当前临床实践，以便进行调整，更好地遵循建议并改善RM的使用。
分析了2010年至2023年期间在26个中心的LATITUDE（波士顿科学公司）远程网络上随访的6553例CIED患者的数据。RM的中位持续时间为40个月。
在观察期内患者入组显著增加。植入后2周内入组的患者比例为73%，3个月内为94%。在数据提取时，14%的患者连接中断。对于所有CIED类型，96%的患者至少每3个月进行一次定期设备传输编程。2023年，进行了6600次门诊问询，并审查了70453次远程传输。定期传输占总数的52%，患者发起的问询占28%，警报传输占20%。
RM在临床实践中的使用正在增加，门诊和远程就诊更多。各中心未采用基于警报的RM策略，而该策略可使他们减轻无实际意义的远程和门诊就诊的重大负担。
