The clinical use of remote parameter testing during cardiac implantable electronic devices implantation procedures: a single center, randomized, open-label, non-inferiority trial

Background

A novel non-contact system for remote parameter testing and reprogramming offers an alternative method for assessing device parameters during cardiac implantable electronic devices (CIEDs) implantation without the need for physical contact with the manufacturer's clinical service technician. The safety and feasibility of using this system in CIEDs implantation procedures remains to be determined.

Objective

Evaluate the safety and feasibility of remote parameter testing in CIEDs implantation procedures.

Methods

A single center, randomized, open-label, non-inferiority trial (ChiCTR2200057587) was conducted to compare the two approaches for interrogating CIEDs during implantation procedures: routine interrogation performed by on-site technicians or remote interrogation performed by technicians using the 5G-Cloud Technology Platform. Patients aged ≥18 years and elected to receive CIEDs were eligible for inclusion. The primary endpoint was the completion rate of the parameter test. Safety and efficiency were evaluated in all randomly assigned participants.

Results

A total of 480 patients were finally enrolled and were randomly assigned to routine group (n = 240) or remote group (n = 240). The primary endpoint was achieved by 100% in both groups (P = 0.0060 for noninferiority). The parameters of sensing, threshold, and impedance regarding the right atrium, right ventricle, and left ventricle had no statistical significance between the two groups (P > 0.05). Procedure time, parameter testing time, and both duration and dose of x-ray irradiation were not significantly different between the two groups (P > 0.05). Shut-open door frequency was significantly higher in the routine group than the remote group [6.00 (4.00, 8.00) vs. 0, P < 0.0001]. Notably, no clinical or technical complications were observed in the remote group.

Conclusions

Remote parameter testing is safe and feasible across various devices implantation procedures. The utilization of remote parameter testing and reprogramming could represent an innovative approach to improve healthcare accessibility and unlock the full potential of secondary centers in managing CIEDs.

The Registration Identification

ChiCTR2200057587.

Remote-control Interrogation, Testing, and Reprogramming of Cardiac Implantable Electronic Devices with Telehealth Protocol for the Management of Patients at Home: The DOMUM REMOTUS Study

Remote control (RC) of cardiac implantable electronic devices (CIEDs) has been tested as safe and effective in the magnetic resonance imaging space. We sought to evaluate RC applications of patients at home. RC of cardiac devices in patients' homes is feasible, safe, and effective, with consistent patient satisfaction. Patients with CIEDs using the CareLink™ network (Medtronic, Minneapolis, MN, USA) participated in a pair of home RC sessions. A technician visited the patient's house and set up a telehealth tablet and a programmer, which included inputting a session key enabling programmer access via a third-party host. The investigator video-conferenced with the patient and remotely controlled the programmer for device testing and data assessment, using a cellular hotspot for Internet connection. Reprogramming was performed as necessary. In all cases, an RC session legend was programmed in the device information field as a control. The patients then completed an experience questionnaire. One hundred fifty patients (99 pacemakers and 51 implantable cardioverter-defibrillators) completed 2 RC sessions, for 300 RC sessions in total. There were no complications or communication interruptions once the system communication proved stable after the first minute. In 26 sessions, initial communication was interrupted upon device interrogation, requiring communication to be re-established (which sometimes necessitated switching to an alternative carrier). Clinically driven parameter reprogramming was performed in 58 RC sessions (39%). Programming of notations concerning RC sessions was performed in all 300 sessions. The average duration of the RC sessions was 11 min. Patients' satisfaction scored 4.5 out of 5 points. In conclusion, RC management of cardiac devices at patients' homes is safe, effective, convenient, and associated with high patient satisfaction. This technology may prove very useful in a changing health care delivery system, especially amid the coronavirus disease 2019 pandemic.

Implantable cardiac devices: the utility of remote monitoring in a paediatric and CHD population

Remote monitoring in the modern era has improved outcomes for patients with cardiac implantable electronic devices. There are many advantages to remote monitoring, including improved quality of life for patients, decreased need for in-office interrogation, and secondary reduced costs. Patient safety and enhanced survival remain the most significant benefit. With most of the published literature on this topic being focussed on adults, paediatric outcomes continue to be defined. This is a review of the benefits of remote monitoring in paediatrics and in patients with CHD.