Role of Automatic Wireless Remote Monitoring Immediately Following ICD Implant: The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) Trial

Niraj Varma, Andrew E. Epstein, Robert Schweikert, Justin Michalski, Charles Love

Research output: Contribution to journalArticle

Abstract

Automatic Remote Monitoring of ICD Follow-Up Introduction The incidence of unscheduled encounters and problem occurrence between ICD implant and first in-person evaluation (IPE) recommended at 12 weeks is unknown. Automatic remote home monitoring (HM) may be useful in this potentially unstable period. Methods and Results ICD patients were randomized 2:1 to HM enabled post-implant (n = 908) or to conventional monitoring (CM; n = 431). Groups were compared between implant and prior to first scheduled IPE for IPE incidence, causes, and actionability (reprogramming, system revision, medication changes) and event detection time. HM and CM patients were similar (mean age 63 years, 72% male, LVEF 29%, primary prevention 73%, DDD 57%). In the post-implant interval assessed (HM 100 ± 21.3 days vs. CM 101 ± 20.8 days, P = 0.54), 85.4% (776/908) HM patients and 87.7% CM (378/431) patients had no cause for IPE (P = 0.31). When IPE occurred, actionability in HM (64/177 [36.2%]) was greater versus CM (15/62 [24.2%], P = 0.12). Actionable items were discovered sooner with HM (P = 0.025). Device reprogramming or lead revision was triggered following 53/177 (29.9%) IPEs in HM versus 9/62 (14.5%) in CM (P = 0.018). Arrhythmia detection was enhanced by HM: 276 atrial and ventricular episodes were detected in 135 follow-ups in contrast to CM (65 episodes at 17 IPEs). More silent arrhythmic episodes were discovered by HM (7.2% vs. 1.5% [P = 0.15]). Since 27/42 (64.3%) IPEs driven by HM alerts were actionable, event notification was a valuable method for problem detection. Importantly, HM did not increase incidence of non-actionable IPEs (P = 0.72). Conclusion Activation of automatic remote monitoring should be encouraged soon post-ICD implant.

Original languageEnglish (US)
Pages (from-to)321-326
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume27
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Equipment and Supplies
Physiologic Monitoring
Incidence
Medication Systems
Dichlorodiphenyldichloroethane
Primary Prevention
Cardiac Arrhythmias

Keywords

  • defibrillators
  • follow-up
  • patient monitoring
  • remote monitoring

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Role of Automatic Wireless Remote Monitoring Immediately Following ICD Implant : The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) Trial. / Varma, Niraj; Epstein, Andrew E.; Schweikert, Robert; Michalski, Justin; Love, Charles.

In: Journal of Cardiovascular Electrophysiology, Vol. 27, No. 3, 01.03.2016, p. 321-326.

Research output: Contribution to journalArticle

@article{39690d4df49541b2bc44d53840eb2994,
title = "Role of Automatic Wireless Remote Monitoring Immediately Following ICD Implant: The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) Trial",
abstract = "Automatic Remote Monitoring of ICD Follow-Up Introduction The incidence of unscheduled encounters and problem occurrence between ICD implant and first in-person evaluation (IPE) recommended at 12 weeks is unknown. Automatic remote home monitoring (HM) may be useful in this potentially unstable period. Methods and Results ICD patients were randomized 2:1 to HM enabled post-implant (n = 908) or to conventional monitoring (CM; n = 431). Groups were compared between implant and prior to first scheduled IPE for IPE incidence, causes, and actionability (reprogramming, system revision, medication changes) and event detection time. HM and CM patients were similar (mean age 63 years, 72{\%} male, LVEF 29{\%}, primary prevention 73{\%}, DDD 57{\%}). In the post-implant interval assessed (HM 100 ± 21.3 days vs. CM 101 ± 20.8 days, P = 0.54), 85.4{\%} (776/908) HM patients and 87.7{\%} CM (378/431) patients had no cause for IPE (P = 0.31). When IPE occurred, actionability in HM (64/177 [36.2{\%}]) was greater versus CM (15/62 [24.2{\%}], P = 0.12). Actionable items were discovered sooner with HM (P = 0.025). Device reprogramming or lead revision was triggered following 53/177 (29.9{\%}) IPEs in HM versus 9/62 (14.5{\%}) in CM (P = 0.018). Arrhythmia detection was enhanced by HM: 276 atrial and ventricular episodes were detected in 135 follow-ups in contrast to CM (65 episodes at 17 IPEs). More silent arrhythmic episodes were discovered by HM (7.2{\%} vs. 1.5{\%} [P = 0.15]). Since 27/42 (64.3{\%}) IPEs driven by HM alerts were actionable, event notification was a valuable method for problem detection. Importantly, HM did not increase incidence of non-actionable IPEs (P = 0.72). Conclusion Activation of automatic remote monitoring should be encouraged soon post-ICD implant.",
keywords = "defibrillators, follow-up, patient monitoring, remote monitoring",
author = "Niraj Varma and Epstein, {Andrew E.} and Robert Schweikert and Justin Michalski and Charles Love",
year = "2016",
month = "3",
day = "1",
doi = "10.1111/jce.12895",
language = "English (US)",
volume = "27",
pages = "321--326",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Role of Automatic Wireless Remote Monitoring Immediately Following ICD Implant

T2 - The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) Trial

AU - Varma, Niraj

AU - Epstein, Andrew E.

AU - Schweikert, Robert

AU - Michalski, Justin

AU - Love, Charles

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Automatic Remote Monitoring of ICD Follow-Up Introduction The incidence of unscheduled encounters and problem occurrence between ICD implant and first in-person evaluation (IPE) recommended at 12 weeks is unknown. Automatic remote home monitoring (HM) may be useful in this potentially unstable period. Methods and Results ICD patients were randomized 2:1 to HM enabled post-implant (n = 908) or to conventional monitoring (CM; n = 431). Groups were compared between implant and prior to first scheduled IPE for IPE incidence, causes, and actionability (reprogramming, system revision, medication changes) and event detection time. HM and CM patients were similar (mean age 63 years, 72% male, LVEF 29%, primary prevention 73%, DDD 57%). In the post-implant interval assessed (HM 100 ± 21.3 days vs. CM 101 ± 20.8 days, P = 0.54), 85.4% (776/908) HM patients and 87.7% CM (378/431) patients had no cause for IPE (P = 0.31). When IPE occurred, actionability in HM (64/177 [36.2%]) was greater versus CM (15/62 [24.2%], P = 0.12). Actionable items were discovered sooner with HM (P = 0.025). Device reprogramming or lead revision was triggered following 53/177 (29.9%) IPEs in HM versus 9/62 (14.5%) in CM (P = 0.018). Arrhythmia detection was enhanced by HM: 276 atrial and ventricular episodes were detected in 135 follow-ups in contrast to CM (65 episodes at 17 IPEs). More silent arrhythmic episodes were discovered by HM (7.2% vs. 1.5% [P = 0.15]). Since 27/42 (64.3%) IPEs driven by HM alerts were actionable, event notification was a valuable method for problem detection. Importantly, HM did not increase incidence of non-actionable IPEs (P = 0.72). Conclusion Activation of automatic remote monitoring should be encouraged soon post-ICD implant.

AB - Automatic Remote Monitoring of ICD Follow-Up Introduction The incidence of unscheduled encounters and problem occurrence between ICD implant and first in-person evaluation (IPE) recommended at 12 weeks is unknown. Automatic remote home monitoring (HM) may be useful in this potentially unstable period. Methods and Results ICD patients were randomized 2:1 to HM enabled post-implant (n = 908) or to conventional monitoring (CM; n = 431). Groups were compared between implant and prior to first scheduled IPE for IPE incidence, causes, and actionability (reprogramming, system revision, medication changes) and event detection time. HM and CM patients were similar (mean age 63 years, 72% male, LVEF 29%, primary prevention 73%, DDD 57%). In the post-implant interval assessed (HM 100 ± 21.3 days vs. CM 101 ± 20.8 days, P = 0.54), 85.4% (776/908) HM patients and 87.7% CM (378/431) patients had no cause for IPE (P = 0.31). When IPE occurred, actionability in HM (64/177 [36.2%]) was greater versus CM (15/62 [24.2%], P = 0.12). Actionable items were discovered sooner with HM (P = 0.025). Device reprogramming or lead revision was triggered following 53/177 (29.9%) IPEs in HM versus 9/62 (14.5%) in CM (P = 0.018). Arrhythmia detection was enhanced by HM: 276 atrial and ventricular episodes were detected in 135 follow-ups in contrast to CM (65 episodes at 17 IPEs). More silent arrhythmic episodes were discovered by HM (7.2% vs. 1.5% [P = 0.15]). Since 27/42 (64.3%) IPEs driven by HM alerts were actionable, event notification was a valuable method for problem detection. Importantly, HM did not increase incidence of non-actionable IPEs (P = 0.72). Conclusion Activation of automatic remote monitoring should be encouraged soon post-ICD implant.

KW - defibrillators

KW - follow-up

KW - patient monitoring

KW - remote monitoring

UR - http://www.scopus.com/inward/record.url?scp=84960798787&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960798787&partnerID=8YFLogxK

U2 - 10.1111/jce.12895

DO - 10.1111/jce.12895

M3 - Article

C2 - 26661687

AN - SCOPUS:84960798787

VL - 27

SP - 321

EP - 326

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 3

ER -