Remote control of implanted devices through Home Monitoring™ technology improves detection and clinical management of atrial fibrillation

To evaluate the impact of Home Monitoring (TM) (HM) technology on detection and treatment of atrial fibrillation (AF). One hundred and sixty-six patients (mean age 73 +/- 10 years, 112 males) received HM devices [121 pacemakers, 22 implantable cardioverter defibrillators (ICDs), and 23 ICDs combined with cardiac resynchronization therapy]. A nurse consulted the cardioreports on the website and submitted the alerts for AF (new onset AF, persistent AF, and AF burden of > 10% for > 5 consecutive days) to the physician. During a mean follow-up of 488 +/- 203 days, 42 patients (26%) had alerts for AF. Twenty-two patients had no history of AF before implant. In nine patients, no further action was taken. For the remaining 33 patients, an unscheduled follow-up was performed: in 16, antiarrhythmic drug therapy was introduced/modified; in 15, anticoagulation was started; in 2, antiplatelet drugs were introduced; in 7, an external cardioversion was performed; in 2 patients, the device was reprogrammed to avoid intermittent atrial undersensing during AF; and in 4 patients, no further action was taken. In four cases the arrhythmia was not confirmed (false positive). The median time to the first intervention for AF was 50 days (148 days before the scheduled follow-up). The HM technology allowed early detection of AF in paced patients and early reaction to optimize medical treatment.