Remote day one post implant monitoring of new devices: The MonashHeart experience

Background: Although present in high energy devices for some time, many of the latest generation of bradyarrhthmia devices also offer remote monitoring capability. This is mainly used for long-term follow-up of devices but offers new opportunities to remotely check new implants – of particular relevance given the wide geographical area served by our centre. Methods: Data was collected prospectively from March 2014 to January 2015 from patients who had device implanted at MonashHeart,Clayton and remotely checked next day with help of nursing staff at Dandenong Hospital by technologist at implantation site. Results: Total 47 patients with mean age 80 years were enrolled. In 33(70%) cases all required data (including atrial/ventricular threshold checks) were available via remote monitoring. Three showed previously undetected AF. For remaining cases automatic RV thresholds were not provided by remote service, however magnet EGMs confirmed capture. Subsequent manual interrogation demonstrated satisfactory thresholds. Automated device check was unsuccessful in 14 (30%) because of automated threshold checks timing being incorrectly set in two devices, high ventricular rates in four devices, and device inability to perform automated threshold check in seven devices. Conclusion: In over 70% devices remote monitoring capability confirmed acceptable ventricular and (where applicable) atrial thresholds. They also provided early warning of atrial tachyarrhythmias. For remainder, 30% thresholds were not available although safe capture was confirmed through magnet EGMs. This suggests a reduction, although not a total elimination, of one day post-implant in manual device checks is possible.