Ventricular Arrhythmia Alerts in Remotely Monitored Implantable Cardioverter Defibrillator Patients: Impact of Manufacturer Differences in Notification Times on Alert Frequency and Patient Management

Abstract

The early notification of alert events via remote monitoring (RM) is associated with improved patient outcomes and is the standard of care for device patients. This retrospective review aimed to investigate manufacturer differences in the timing, type and frequency of alert notifications, and their impact on patient management and clinic workload. The frequency of alerts for shocks, anti-tachycardia pacing, and non-sustained ventricular tachycardia was retrospectively reviewed in 557 RM implantable cardioverter defibrillator patients followed between January and December 2021. Manufacturer, alert notification time, and action taken by the clinic were analysed. Descriptive statistical analyses were performed using Pearson’s Chi-squared test. Of 2,666 transmissions, 1,263 (47.4%) were alert transmissions, with 540 (42.8%) alerts for ventricular arrhythmia (VA). Alert frequency for VA was significantly different between device manufacturers: Abbott 40.6%, Biotronik 47.0%, Boston 9.8%, and Medtronic 2.6% (p<0.001). Overall, VA notification times varied by manufacturer: 3.04 days (Abbott), 2.18 days (Biotronik), 28.27 days (Boston Scientific), and 46.72 days (Medtronic) (p<0.001). Shock notification timing did not significantly vary between manufacturers. Referral for clinician review occurred in 14.3% of VA alert transmissions. No action was required for 78.3% of VA alerts. Unplanned RM alert transmissions comprise a significant proportion of device clinic workload, with most VA alerts requiring no action. There is variation in alert frequency and notification time based on manufacturer, which highlights challenges for clinics in managing this unplanned workload.