Bluetooth-enabled implantable cardiac monitors and two-way smartphone communication for patients with hypertrophic cardiomyopathy

ABSTRACT Background SCD risk stratification in HCM currently relies on arrhythmic burden quantification by 24 or 48-hour Holter monitoring. It is unclear if this approach adequately captures arrhythmic burden compared to longer term continuous monitoring. We sought to assess the long-term incidence of non-sustained ventricular tachycardia (NSVT) in HCM patients at low or moderate SCD risk using implantable cardiac monitors (ICMs) paired with a novel Bluetooth-enabled two-way communication platform. Methods This is a prospective, single-arm observational study enrolling thirty-three HCM patients. Patients were implanted with an Abbott Confirm Rx ICM and monitored using a protocolized care pathway. Results 20 (60.6%) patients had ≥1 episode of NSVT recorded on ICM, the majority of which had previous Holters that did not identify NSVT (60%, n= 12). 71 episodes of NSVT were detected in total. Median time to first NSVT detection was 76.5 days (0-553). 19 patients underwent primary prevention implantable cardioverter defibrillator (ICD) implantation during an average follow-up of 544 days (42-925). A total of 172,112 automatic transmissions were received and 65 (0.04%) required clinical follow-up. 325 manual transmissions were received and managed. 14 (4.3%) manual transmissions required follow-up whereas 311 (95.7%) were managed solely with a written text message. Conclusion Surveillance and reporting systems utilizing two-way communication enabled by novel ICMs are feasible and allow remote management of patients with HCM. Prolonged monitoring identified more patients with non-sustained arrythmias than standard Holter monitoring. In many cases, this information impacted SCD risk stratification and had an affected patient management.