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Automatic remote monitoring: milestones reached, paths to pave.

Automatic remote Home Monitoring™ is a transforming technology in the evolution of cardiovascular implantable electronic devices (CIEDs).1 However, innovations are usually greeted guardedly, especially ones which demand changes in clinical habits. When and how these should be applied are obvious questions to physicians and patients alike. Automatic remote monitoring (RM)—with its finer distinctions of operation, i.e. remote follow-up vs. remote (or continuous) monitoring2—has been no exception. During a decade after its introduction, clinical implementation has progressed from initial curiosity and occasional use, through studies demonstrating reliability and clinical applications, to several large-scale prospective trials.3 Their results have been impressive and remarkably consistent, improving upon current standard of care and opening new avenues for exploration. Notably, when directly compared with recommended conventional in-person follow-up (the TRUST control arm providing this first evaluation), Home Monitoring™ secured greater retention of patients and also improved punctuality and adherence to scheduled evaluations.4,5 The safe and effective replacement of the bulk of ‘routine’ in-clinic evaluations has a huge implication for resource utilization. This effect was coupled with capability for same day discovery of problems (even when asymptomatic), with appropriate technology, and clinical infrastructure in place.6 This was an outlandish concept even a few years ago when advance to 5.7 months with remote management was considered ‘early’.7

The most obvious application of RM is for detection of system dysfunction.8 Most triggered alerts demanded reprogramming. Correct programming itself imparts survival benefit.9 Needs are anticipated to change over time. Remote monitoring has significant value under these conditions, e.g. to reduce inappropriate shocks.10 Although safety concerns underpinned original post-implant follow-up schedules, e.g. for assessing pacing thresholds, integrity of components, and charging capacitors, these issues now belong to a different era. Current generation devices require no such maintenance, have …