Long-term remote monitoring vs. in-office monitoring of pacemakers: a systematic review and meta-analysis

Abstract

Abstract Background Remote monitoring (RM) is increasingly recognised as the standard of care for patients with cardiac implantable electronic devices (CIEDs) according to current practice guidelines, particularly in pacemaker usage which represents the majority of CIEDs. However, there is insufficient evidence to assess the long-term safety of RM compared to in-office (IO) monitoring of pacemakers over extended periods, as well as its effectiveness in reducing in-office visits for device reprogramming. Purpose We aimed to perform a meta-analysis to compare RM and IO monitoring of pacemakers with at least 12 months of follow-up. Methods We systematically systematic search EMBASE, PubMed/MEDLINE, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing remote monitoring (RM) and in-office (IO) monitoring of pacemakers, with a focus on outcomes related to (1) all-cause mortality, (2) stroke, and (3) hospitalizations due to cardiovascular and device-related adverse events. Heterogeneity was assessed using I² statistics, and outcomes with high heterogeneity were analysed using a random-effects model. Results Six RCTs with a total of 3,059 patients were included in the meta-analysis. Of these, 1,495 patients (48.87%) underwent RM. In-office number of follow-ups per year was not significantly different between groups (OR -0.71; 95% CI -1.45 - 0.03; p = 0.06; I² = 99%; Fig. 1a) but tended to favour the RM group. No significant differences were found between RM and IO monitoring in terms of all-cause mortality (OR 1.14; 95% CI 0.83 - 1.55; p = 0.42; I² = 0%; Fig. 1b), stroke (OR 0.82; 95% CI 0.37 - 2.19; p = 0.82; I² = 38%; Fig. 2a), or hospitalizations for cardiovascular or device-related adverse events (OR 0.96; 95% CI 0.72 - 1.28; p = 0.78; I² = 0%. Fig. 2b). Conclusion This is the first meta-analysis comparing RM and IO monitoring for long-term pacemaker usage. Our results suggest that the number of follow-ups tended to be fewer in the RM group, and both monitoring methods appear to be similar in terms of all-cause death, stroke, and hospitalizations for cardiovascular or device-related adverse events.