Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes

• Published in: Journal of the American College of Cardiology Vol. 65; no. 24; pp. 2591 - 2600
• Main Authors: Parthiban, Nirmalatiban, Esterman, Adrian, Mahajan, Rajiv, Twomey, Darragh J, Pathak, Rajeev K, Lau, Dennis H, Roberts-Thomson, Kurt C, Young, Glenn D, Sanders, Prashanthan, Ganesan, Anand N
• Format: Journal Article
• Language: English
• Published: United States 23-06-2015
• Subjects: Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - therapy; Defibrillators, Implantable - standards; Electric Countershock - methods; Electric Countershock - standards; Humans; Randomized Controlled Trials as Topic - methods; Remote Sensing Technology - methods; Remote Sensing Technology - standards; Treatment Outcome; mortality; home monitoring; sudden cardiac death; shock
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2015.04.029

Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up.
This study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up.
Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up.
In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002).
Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.