Abstract

Background: In case of ICD lead dysfunction, interference signals can be misinterpreted as ventricular fibrillation, leading to inappropriate shocks, which are harmful and traumatic for patients. This study retrospectively analyzed a large single-center device registry to assess the clinical impact of remote monitoring on electrode defects in relation to symptoms, presentation mode, and treatment.
Method: Adult ICD and S-ICD patients who underwent lead revision between 2015 and 2023 were included. Two groups were identified: a conservatively ambulatory monitored control group and a telemonitored group. Data were descriptively analyzed. Logistic regression was used for “number of inappropriate shocks”, and Kaplan-Meier for “time from detection of RV lead defect to revision”.
Result: Numbers of actively telemonitored patients increased from 2017 to 2023 from 0 to 109. Of in total 146 telemonitored patients during that time frame, 5 (3.4%) underwent revision for electrode defects, compared to 145 (4.7%) of 3056 conservatively monitored patients. Eleven patients in the control group and none in the telemonitored group experienced inappropriate shocks (p=0.792). The time from defect detection to revision was shorter in the telemonitored group (4.0 vs. 30.9 days, p=0.692). Most patients with defective lead presented because of a warning tone/vibration alarm (29.9%), followed by the defect being diagnosed during a planned ambulatory ICD interrogation (20.4%). 6.4% of patients experienced an inappropriate shock. For most patients, the setting of diagnosis of the defect was either their cardiologist or the outpatient office of a university hospital (together 49.0%). 26.8% presented directly in the emergency room.
Conclusion: Remote monitoring reduced inappropriate shocks by enabling earlier detection of lead defects. Expanding telemonitoring may improve early detection and may prevent inappropriate shocks and utilization of emergency medicine services.

Keywords:ICD lead dysfunction; ICD lead revision; Telemonitoring; Inadequate shocks