Remote implantable cardioverter defibrillator monitoring in a Brugada syndrome population.
OBJECTIVE
The diagnosis of Brugada syndrome (BS) is typically made in a young and otherwise healthy population. In patients with a high risk of sudden cardiac death (SCD), the only currently recommended therapy is an implantable cardioverter defibrillator (ICD), but these are not without complications. We investigated whether remote ICD monitoring could simplify follow-up and detect potential complications in these patients.


RESULTS
Thirty-five consecutive patients (26 males, 44 +/- 11 years) implanted with an ICD for BS with a remote monitoring ['Home Monitoring' (HM), Biotronik, Germany] system were prospectively enrolled in this study. They were matched for age, sex, and follow-up duration with 35 BS patients implanted with an ICD without this capability. During a mean follow-up of 33 +/- 17 months, the number of cardiology consultations was significantly lower in the HM group (3 +/- 2 vs. 7 +/- 3; P < 0.001). Inappropriate shock(s) [IS(s)] occurred in three patients (8.5%) in the HM group vs. six (17%) in the control group (P = NS). Ten patients in the HM group had a median of four alerts ('ventricular tachycardia/ventricular fibrillation detection' in all patients, 'shock' in three, 'ineffective shock' in two patients with shock on noise, 'extreme ventricular pacing impedance' in one patient due to lead failure, and 'deactivated therapy' in two patients with lead failure before replacement). In 5 of these 10 patients, prompt reprogramming of the ICD may have prevented IS(s).


CONCLUSIONS
Remote ICD monitoring in patients with BS decreases outpatient consultations and may help prevent ISs.
Sacher
Frédéric
F
CHU de Bordeaux, Université Bordeaux II, France. frederic.sacher@chu-bordeaux.fr
Probst
Vincent
V
Bessouet
Maider
M
Wright
Matthew
M
Maluski
Alexandre
A
Abbey
Sélim
S
Bordachar
Pierre
P
Deplagne
Antoine
A
Ploux
Sylvain
S
Lande
Gilles
G
Jaïs
Pierre
P
Hocini
Mélèze
M
Haïssaguerre
Michel
M
Le Marec
Hervé
H
Clémenty
Jacques
J
D000328:Adult; D000554:Ambulatory Care Facilities; D053840:Brugada Syndrome / Q000503:physiopathology / Q000628:therapy*; D016022:Case-Control Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D004868:Equipment Failure; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000517:prevention & control*; D017216:Telemedicine / Q000379:methods*