Remote Monitoring of Implantable Cardioverter-Defibrillators A Systematic Review and Meta-Analysis of Clinical Outcomes

Nirmalatiban Parthiban, Adrian Esterman, Rajiv Mahajan, Darragh Twomey, Rajeev Pathak, Dennis Lau, Kurt Roberts-Thomson, Glenn Young, Prashanthan Sanders, Anand Ganesan

    Research output: Contribution to journalReview articlepeer-review

    104 Citations (Scopus)

    Abstract

    Abstract Background Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up. Objectives This study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up. Methods Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up. Results In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002). Conclusions Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.

    Original languageEnglish
    Article number21287
    Pages (from-to)2591-2600
    Number of pages10
    JournalJournal of The American College of Cardiology
    Volume65
    Issue number24
    DOIs
    Publication statusPublished - 2015

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