Reorganizing the device clinic: remote monitoring-only of cardiac implantable electronic devices during the Covid-19 pandemic

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 pandemic has caused a necessary reorganization of the elective outpatient device clinic. Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has already been validated as a safe and effective tool to follow patients, limiting the need for in-person visits. Aim of our study was providing a snapshot of the current clinical practice in a tertiary electrophysiology center in Italy and suggesting a potential model of care for patients with CIEDs. Methods and Results Before the COVID-19 pandemic, patients with implantable cardioverter defibrillators/cardiac resynchronization therapy (ICD/CRTs) were evaluated in the device clinic twice a year and patients with pacemakers (PMs) once a year; loop recorder (ILR) patients were followed remotely only. In the COVID-19 period (March 2020-February 2021) RM was implemented for all compatible CIEDs. Patients with RM were not seen in clinic anymore and were followed with RM. In the COVID-19 period, 100% of newly implanted devices received RM (82 ILR, 194 PMs, 80 ICDs/CRTs), compared to 68% in the same months of 2019 (106/106 ILR, 83/203 PMs, 78/82 ICD/CRTs), p<0.01. In addition, 502 previously implanted patients with RM compatible devices were contacted and received RM in the COVID-19 period. By the end of February 2021, a total of 1676 patients were remotely monitored at our Institution, with a potential saving of outpatient visits of 1683 visits/year, against an average of 8514 RM transmissions/year needing evaluation. During the study period, we observed 213 clinical events that triggered an urgent manual transmission and/or required physician’s intervention (table 1), successfully resolved over the following 24 h. None of the 1676 patients presented to the emergency room with a problem that went unnoticed by the RM system. Conclusion RM of CIEDs is an essential tool to reduce in-person visits during the COVID-19 pandemic and seems to be safe in terms of events detection. The potential for elective outpatient appointments reduction has to be counterbalanced by the sustainability of a large number of transmissions and data to analyze.