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Atrial fibrillation and remote monitoring through cardiac implantable electronic devices in heart failure patients

Remote monitoring (RM) is the application of communication technology to patients carrying cardiac implantable electronic devices (CIEDs), such as pacemakers, cardioverter-defibrillators (ICDs), or devices for cardiac resynchronization therapy (CRT). RM allows to remotely check device system functions limiting the need for in-hospital checks. The earlier detection of technical issues such as lead fracture, insulation defect or battery exhaustion, may also allow timely appropriate interventions.1,2 RM is nowadays the standard of care for CIED system checks during the post-implant follow-up, especially for ICDs and CRT-D devices. An additional dimension of the clinical use of RM is disease management. Remote monitoring enables to evaluate the dynamic changes in patient status, such as onset and progression of atrial fibrillation (AF) and onset, worsening and progression of heart failure, or important changes in heart rate, respiratory rates and indices of physical activity.1,2 The background of disease management is that patient care can benefit from automatic or regular data transmission, coupled with alert features, transmitted to physicians and nurses at a follow-up clinic when significant abnormalities in a series of functional parameters are detected, with the possibility of reacting with corrective and preventive actions, if needed. In recent years, the challenge for RM was to obtain the proof of evidence that this type of management is feasible, effective and cost-effective.3–5 At present, the data supporting a benefit of RM on patient outcomes, as compared with conventional follow-up, are scarce. To our knowledge, the IN-TIME trial is the only study that found a significant reduction in a composite clinical score (death or hospital admission or changes in patient status), with the benefit driven by a lower mortality in the RM group, achieved through