Follow‐Up of CRT‐ICD: Implications for the Use of Remote Follow‐Up Systems. Data from the InSync ICD Italian Registry

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Abstract
Background: Launch of remote follow‐up systems in Europe is currently underway. However, there is insufficient understanding of postimplant practices with respect to device follow‐up, reprogramming of device features, and postshock clinic visits. Methods: We analyzed device‐stored data from patients implanted with biventricular defibrillators (CRT‐ICD) to characterize the management of patients in current clinical practice and the potential impact of remote follow‐up systems. Results: Two hundred and seventeen patients were identified, all with complete device‐data for at least one year. Over a follow‐up period of 570 ± 158 days, 1,959 device interrogations were performed. Of these, the majority (1,280, 65%) involved the reprogramming of device parameters. The mean time interval between interrogations was 70 ± 25 days. Overall, a marked reduction of interrogations requiring reprogramming was observed between the first six months of follow‐up and subsequent periods (from 3.6 ± 1.8 to 1.1 ± 1.0 interrogations/six months). A mean of 6.0 ± 5.9 device parameters was reprogrammed during the first six months of follow‐up, versus 4.4 ± 5.6 (P = 0.000) during the subsequent period. From multivariate analysis, a higher‐than‐median number of interrogations was found to be significantly associated with defibrillator shocks (OR:2.51; 95%CI:1.42–4.42). Following a shock, a total of 133 interrogations in 60 patients were performed with 80% of these occurring within five days of the shock, and 49% did not require device reprogramming. Conclusion: Six months after implant, reprogramming of device parameters is significantly less frequent, making the use of remote follow‐up systems a practical alternative for patients and physicians. Moreover, a considerable portion of post‐shock interrogations does not involve reprogramming and may therefore be performed remotely.