Clinical utility of remote monitoring for patients with cardiac implantable electrical devices

Background Remote monitoring of cardiac implantable electronic devices (CIEDs) offers practical and clinical benefits juxtaposed against burdens associated with high transmission volume. Methods We identified patients receiving de novo pacemakers (PPMs) and implantable cardiac defibrillators (ICDs) at a single academic medical center (January 2016-December 2019) with at least 1 year of follow-up device care. We collected patient- and device-specific data at time of implant and assessed all remote and in-person interrogation reports for clinically actionable findings based on pre-specified criteria. Results Among 963 patients (mean age of 71 (+/- 14) years, 37% female), 655 (68%) underwent PPM, and 308 (32%) underwent ICD implant. Median follow-up was 874 (627-1221) days, during which time patients underwent a mean of 13 (10-16) total interrogations; remote interrogations comprised 53% of all device evaluations; and of these, 96% were scheduled transmissions. Overall, 22% of all CIED interrogations yielded significant findings with a slightly higher rate in the PPM than in the ICD group (23% vs. 20%, p < 0.01). Only 8% of remote interrogations produced clinically meaningful results, compared with 38% of in-person ones. In adjusted models, routine, remote transmissions were least likely to be useful for both PPM and ICD patients (p< 0.001), whereas time from initial device implant was inversely associated with probability of obtaining a useful interrogation (p < 0.001). Conclusions Routine remote interrogations constitute the majority of device evaluations performed, but uncommonly identify clinically actionable findings.