179: Remote monitoring follow-up of 533 ICD/CRT-D recipients: a very low rate of inappropriate shocks

Remote monitoring (RM) is now accepted as a safe alternative to standard follow-up (sFU) for ICD recipients (ICDr). Methods We analysed the long term outcomes of 533 ICD/CRT-Dr. Patients were equipped with Boston Scientific Latitude (45%), Medtronic Carelink (43%), St Jude Medical Merlin (9%) or Biotronik Home Monitoring (3%) RM systems. Automatic FU with RM was performed every 3 months, with at least one sFU /year. In emergency cases patients were invited visits. ICD programming was done with 2 zones (VT zone>180 bpm / VF zone>220 bpm). All RM alerts and related EGMs as well as the reasons and therapies were reviewed by two physicians. Results We enrolled 533 pts (82% male, mean age 66±10 y.o.). 55% had ischemic cardiomyopathy, 69% were primary prevention. CRT-D (46%) and dual chamber (45%) devices were mainly represented. During a RM FU period of 15±8 months, we noted 8 automatic RM FU and 2 sFU visits/patient. 23 deaths occurred. 19 patients had major alerts (5 for ICD lead dysfunction, 1 for ERI, 9 for electrical storm). 2672 non major alerts occurred and led to multiple diagnoses: in 22 pts early detection of unknown AF, in 41 CRT-Dr loss of biventricular pacing. 145 ICD discharges occurred in 52 pts. Within the 66 pts with diagnosed AF by RM, 24 were managed with rhythm control strategy (11 cardioversions, 10 AA drugs introductions, 3 PAF ablations) and 10 (CRT-D) had a rate control strategy (AV node ablations in 6 and beta blocker in 4). 91 appropriate (app) ICD discharges (ICDd) occurred in 35 pts (6,5%) of which 10 were in primary prevention. A first inappropriate ICDd occurred in 3,1% of the population (17 pts) and were mostly due to AF (76%). 74 pts had 1205 app ATP (80% successful). 5 pts with high LV impedance detected by RM had lead dislodgement and underwent reintervention. Conclusion In a large monocentric observational study, RM has demonstrated to be an effective mode of FU for ICDr. Early diagnoses allow rapid management of pts and are associated with a very low rate of inappropriate shocks.