Abstract 11775: Initial US Experience With a Technician Supported Remote Interrogation System for Cardiac Implantable Electronic Devices in the Emergency Department and Perioperative Areas

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Introduction: Patients (Pts) with cardiac implantable electronic devices (CIED)s often require device interrogation and interpretation in the Emergency Department (ED) or perioperative areas (OR) where personnel and equipment to perform this procedure are often not available. CareLink Express (CLE) (Medtronic, Inc.) is a new technician supported real time remote interrogation system designed to facilitate this process. Objective: The aim of this retrospective study was to assess the efficiency of CLE compared to traditional device management (TDM) and examine its findings. Methods: Data from the Medtronic deidentified database were used to assess CLE use and performance in the ED and OR from 01/2012 - 10/2014. All 7044 CLE transmissions from 136 US sites originating in the ED or OR, were compared to 217 TDM requests in 5 geographically diverse US sites where, prior to CLE, CIED interrogations and interpretations were performed by calling an industry representative to the ED or OR. Results: Compared to TDM, CLE resulted in a 78% reduction in the time to device interrogation and interpretation: (100±140 min to 22+14 min, P<0.0001). It improved response time and consistency in both the ED: 82+103 min to 23+18 min P<0.01, and OR: 127+181 min to 16.5+9.5 min P<0.0001. Overall, actionable events (arrhythmia, device/lead abnormalities) (AE) were found infrequently (ED AE: 9.9%; OR: 4.1%). AE were found in only 13.6% of Pts with a perceived shock and 6.5% of those presenting with syncope. AE were much more common in Pts with suspected abnormal device function (30.4%) or audible alerts (52.6%). Pts not enrolled in a remote monitoring system were almost 3 times more likely to have an AE identified than those enrolled in such a program (23.9% vs 8.2%, p<0.0001) and the presence of an older CIED system was associated with an increased likelihood of finding an AE with CLE use (7.4% in year 1 vs 31% after 10 years). Conclusions: The large number of Pts with CIEDs, and the opportunity to quickly and predictably identify the minority with high risk/life-threatening AE from the low risk majority, strongly support CLE as an attractive tool to save time, and improve resource utilization, especially in sites such as the ED and OR which are expensive and place a high priority on efficiency.