Efficacy of Remote Monitoring Systems for Reducing Inappropriate Shocks in Patients with ICD

Introduction: Inappropriate shocks(IAS) were associated with increased risk of mortality and deterioration of QOL in pts with ICD. To investigate the efficacy of remote monitoring systems (RM) for reducing IAS. Methods: We retrospectively reviewed consecutive 202pts who had been implanted ICDs from 2005. Incidence of IAS and device-related problems were reviewed in 101pts under RM (CareLink (n=95)/HomeMonitoring (n=6)) during ≤2yrs and in 101control-pts(C) who underwent conventional scheduled-checks during ≤2yrs after ICD implantation. Results: Age, gender, AF, single-chamber ICD, Fidelis-lead, VF detection rate, treatment with amiodarone and β blockers were not significantly different between RM and C groups, except for idiopathic VF (26vs.18%; p<.05) and LVEF (48vs.42%; p<.05). Kaplan-Meier survival curve revealed significant reduction of IAS under RM compared to C group (p=0.032). A total of 10/15 device-related problems were detected in C/RM groups. Device problems were more often confirmed just after IAS in C than RM group (80vs.27%; p<.01). In RM group, 73% of problems had been managed 2±2 days after data detection and did not cause IAS. Multiple regression analysis showed that RM (OR; 0.29, 95%CI; 0.110.78, p<.05) and age (OR; 0.97, 95%CI; 0.94-0.996, p<.05) were independently associated with IAS. Conclusions: Incidence of IAS may be reduced under RM which enables us to detect device-related problems before the delivery of IAS from ICD.