Parthiban, Nirmalatiban, Esterman, Adrian, Mahajan, Rajiv, Twomey, Darragh J., Pathak, Rajeev K., Lau, Dennis H., Roberts-Thomson, Kurt C., Young, Glenn D., Sanders, Prashanthan, and Ganesan, Anand N. (2015) Remote monitoring of implantable cardioverter-defibrillators: a systematic review and meta-analysis of clinical outcomes. Journal of the American College of Cardiology, 65 (24). pp. 2591-2600.

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Abstract

Background: 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.

Objectives: This study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up.

Methods: 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.

Results: 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).

Conclusions: 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.

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