Effectiveness of remote monitoring in the management of syncope and palpitations.
OBJECTIVE
Recently, the remote transmission of data detected by implantable loop recorders (ILRs) has become available. The aim of this study was to evaluate effectiveness and acceptance of remote monitoring in the clinical management of syncope and palpitations in patients with ILR.


RESULTS
Consecutive patients implanted with ILR (Reveal DX/XT Medtronic, Inc.) and followed up by means of remote monitoring (CareLink(®)) were included. The patients were requested to transmit the data stored in the ILR every week, via the CareLink system, or more frequently during the first period. Patient acceptance of ILR was evaluated by means of a questionnaire concerning physical and mental components. Forty-seven patients (27 males, average age 64 ± 19 years) were enrolled and followed up for 20 ± 13 weeks. Thirty-two patients (68%) had at least one ECG recording of a true relevant event. The mean time from ILR implantation to the first true relevant ECG was 28 ± 49 days, which was 71 ± 17 days less than in the clinical practice of 3-monthly in-office follow-up examinations. Thirty-eight patients (81%) had at least one false arrhythmic event, mainly false asystole and false fast ventricular tachycardia. In the absence of Carelink transmission, at least one episode of memory saturation of ILR would have occurred in 21 patients (45%) that would have limited the diagnostic yield. Patient compliance was good even though one-fifth had some minor psychological concern regarding the ILR implant. CareLink was well accepted and judged easy to use.


CONCLUSIONS
Remote monitoring enhances the diagnostic effectiveness of Reveal, limiting the risk of memory saturation due to the high number of false detections and reducing the time to diagnosis. Both ILR and CareLink were well accepted and well tolerated by the patients, as they were considered useful.
Department of Cardiology, Centro Aritmologico e Syncope Unit, Ospedali del Tigullio, 16033 Lavagna, Italy.
Toshiyuki
T
Furukawa
Roberto
R
Maggi
Cristina
C
Bertolone
Fabrizio
F
Ammirati
Massimo
M
Santini
Renato
R
Ricci
Franco
F
Giada
Michele
M
Brignole
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010349:Patient Compliance; D011446:Prospective Studies; D019736:Prostheses and Implants; D058998:Remote Sensing Technology / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013575:Syncope / Q000503:physiopathology*