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Letters to the Editor|Articles in Press

Reply to the Editor — The promising future of remote monitoring for cardiac implantable electronic devices

Open AccessPublished:February 02, 2023DOI:https://doi.org/10.1016/j.hroo.2023.01.009
      We thank Whitaker and colleagues for their interest in our recent publication on the impact of intensive remote monitoring compared with standard remote monitoring in patients with a cardiac implantable electronic device.
      • Heath K.
      • O'Shea C.J.
      • Thomas G.
      • et al.
      Impact of intensive follow-up of cardiac implantable electronic devices via remote monitoring: a pilot study.
      The utilization of intensive remote monitoring does provide the opportunity to improve the workflow for clinicians and outcomes for patients. The workload from remote monitoring is becoming burdensome
      • O'Shea C.J.
      • Middeldorp M.E.
      • Hendriks J.M.
      • et al.
      Remote monitoring alert burden: an analysis of transmission in >26,000 patients.
      globally, with future studies aimed to improve reduce the impact worldwide necessary.
      Mobile transmitters for more expeditious transmission of alerts have the potential for improving outcomes. However, their use has been limited by the lack of availability across the range of cardiac implantable electronic device manufacturers. In addition, even when available, there are other determinants of their use, particularly that of patient preference. In our study, to mitigate potential bias, we included equal numbers of each manufacturer type. Therefore, we believe that the type of transmitter used in this analysis would not have affected the outcomes. Importantly, the impact of mobile transmitters on clinical endpoints is yet to be evaluated.
      The patients were well matched for cardiovascular comorbidities including heart failure, heart disease, diabetes obesity, and sleep apnea. Unfortunately, we were unable to present the physical activity levels in the patients, but given the similarities seen within the comorbidities presented, it is unlikely that this would have been diverse enough to effect the results. In addition, the pilot nature of our study with limited numbers would be prohibitive to undertake meaningful subgroup comparisons as suggested.
      The total transmissions received from the implantable cardioverter-defibrillators was decreased in the intensive remote monitoring group, but the pacemaker and loop recorder transmissions were increased in the intensive group compared with the standard monitoring group. We do not have a clear understanding of why this may be and suggest that it is likely due to random variation. A larger study with more patients and transmissions might provide further insight into this variation or indeed provide a different outcome.

      Funding Sources

      This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Disclosures

      Dr Middeldorp is supported by a Postdoctoral Fellowship from Cedars-Sinai Medical Center and the American Association for University Women. Dr Sanders is supported by Practitioner Fellowships from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. Dr Sanders reports having served on the advisory board of Boston Scientific, CathRx, Medtronic, PaceMate, and Abbott Medical. Dr Sanders reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Boston Scientific, and Abbott Medical. Dr Sanders reports that the University of Adelaide has received research funding from Medtronic, Abbott Medical, Boston Scientific, and LivaNova on his behalf.

      Authorship

      All authors attest they meet the current ICMJE criteria for authorship.

      References

        • Heath K.
        • O'Shea C.J.
        • Thomas G.
        • et al.
        Impact of intensive follow-up of cardiac implantable electronic devices via remote monitoring: a pilot study.
        Heart Rhythm O2. 2022; (xx:XXX–XXX)
        • O'Shea C.J.
        • Middeldorp M.E.
        • Hendriks J.M.
        • et al.
        Remote monitoring alert burden: an analysis of transmission in >26,000 patients.
        J Am Coll Cardiol EP. 2021; 7: 226-234

      Linked Article

      • To the Editor — The promising future of remote monitoring for cardiac implantable electronic devices
        Heart Rhythm O2
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          We read with interest the article by Heath and colleagues1 in which they evaluated the performance of intensive remote monitoring (IRM) in comparison with standard remote monitoring for patients with a cardiac implantable electronic device. With the advancement of technology and its integration into healthcare, we congratulate the authors on this study and raising the awareness of this topic to the readership. The study found that using IRM led to a significant reduction in the number of actionable alerts and the time taken to review them.
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