B-PO01-002 REMOTE MONITORING OF LOW VOLTAGE CARDIAC IMPLANTABLE DEVICES - A HIGH VOLUME CENTRE EXPERIENCE

Abstract

Unlike patients implanted with high voltage devices who are routinely enrolled in Remote monitoring (RM) programmes, standard practice for low voltage devices is routine in-person (IP) clinic follow up. In response to the COVID-19 pandemic all patients, post implant or under routine follow up in our institution, with low voltage devices were enrolled onto RM to reduce IP clinic visits. There are limited data investigating the real-world efficacy of RM in this population. To assess the feasibility of RM in patients with low voltage devices. All patients with a pacemaker (PPM) or cardiac resynchronisation therapy pacemaker (CRTP) that underwent remote review between 24th June and 31st October 2020 were prospectively assessed. Both de-novo implants and routine follow ups were included. Transmissions that were scheduled, triggered by automated alerts or were as a result of clinician or patient request were reviewed. Time taken to report, and actions taken were assessed. A total of 294 patients were reviewed; 57.5% males, mean age 76 (SD 14) years. This included 228 PPMs and 66 CRTPs (67% de-novo implants and 33% routine follow up); 51% Boston Scientific, 31% Abbott, 18% Medtronic and 1% Biotronik. Overall transmissions; 78% scheduled, 20% alerts, 2% patient request and 0.3% clinician request. Overall mean reporting time was 19 (SD 11) minutes. The mean time was longer for scheduled compared to non-scheduled follow up (19 (SD 10) vs 16 (SD 12) minutes, p=0.0005). There was no difference in the time taken to review PPM and CRTPs (p=0.43). Those patients requiring action following review were significantly longer (21 (SD 12) vs 16 (SD 9) minutes, p=0.002). Of the 52% requiring additional review; 64% were for programming issues, 33% required clinical review (arrhythmia/wound/heart failure), 2% were booked as back-up prior to procedure and a further 1% at patient request. Optimising baseline programming for de-novo implants would have reduced additional review for changes by 29%. RM is feasible in this population and may be used to reduce the number of IP visits. Clinic review may be further reduced by optimising programmed parameters at implant and enhancing patient pathways, specifically with regards to Heart Failure assessment.