0303: Reduction of inappropriate therapies: follow-up of 843 ICD/CRT-D in real life

Purpose Remote monitoring (RM) is now accepted as a safe alternative to standard follow-up (sFU) for ICD. Methods We analyzed the long term arrhythmic events and device-related outcomes of 843 ICD/CRT-D. Patients (pts) were equipped with Boston (44%), Medtronic (40%), St Jude Medical (11%), Biotronik (3%) and Sorin (2%) RM systems. FU started after hospital discharge. Automatic FU with RM was performed every 3 months, with at least one sFU /year. In emergency cases, pts were invited for inhospital control visits. ICDs were programmed with 2 zones (VT zone >180 bpm / VF zone >220bpm). All RM alerts and related EGMs as well as the reasons of therapies were reviewed by two physicians. Results 843 pts (82% male, 64±10 y.o.) were enrolled. 52% had ischemic cardiomyopathy, 44% previous history of AF. 63% were primary prevention ICDs. CRT (46%) and dual chamber (44%) were mainly represented, single chamber 10%. During a FU period of 28±14 months, we noted 16±11 automatic RM FU and 2±1 sFU visits/patient. 87 pts died during FU. 92 pts had major alerts (37 for ICD lead dysfunction, 33 for ERI reached, 18 for electrical storm, 4 therapies off). Within 216 pts with minor alerts, 112 refer to AF, with for 54 pts early detection of unknown AF resulting in therapy modifications. 238 appropriate (app) shocks occurred in 73 pts (9%). 57 inappropriate shocks occurred in 23 pts (3%) and were mainly due to AF (61%, other: sinus tachycardia 9%, lead dysfunction 13%, T oversensing 9%, electromagnetic interference 4%). 141 pts had app ATP (17% of the population). 14 pts with high LV lead impedance detected by RM had LV lead dislodgement and underwent early intervention. Conclusion In a large single center observational study, RM has demonstrated to be an effective method of FU for ICD recipients. Early diagnoses of AF or lead failure allow rapid management of patients and are associated with a very low rate of inappropriate shocks.