title: Decreased delivery of inappropriate shocks achieved by remote monitoring of ICD: a substudy of the ECOST trial.
abstract: BACKGROUND
  Inappropriate shocks remain a highly challenging complication of implantable cardioverter defibrillators (ICD). We examined whether automatic wireless remote monitoring (RM) of ICD, by providing early notifications of triggering events, lowers the incidence of inappropriate shocks.
  
  
  RESULTS
  We studied 433 patients randomly assigned to RM (n = 221; active group) versus ambulatory follow-up (n = 212; control group). Patients in the active group were seen in the ambulatory department once a year, unless RM reported an event requiring an earlier ambulatory visit. Patients in the control group were seen in the ambulatory department every 6 months. The occurrence of first and further inappropriate shocks, and their causes in each group were compared. The characteristics of the study groups, including pharmaceutical regimens, were similar. Over a follow-up of 27 months, 5.0% of patients in the active group received ≥1 inappropriate shocks versus 10.4% in the control group (P = 0.03). A total of 28 inappropriate shocks were delivered in the active versus 283 in the control group. Shocks were triggered by supraventricular tachyarrhythmias (SVTA) in 48.5%, noise oversensing in 21.2%, T wave oversensing in 15.2%, and lead dysfunction in 15.2% of patients. The numbers of inappropriate shocks delivered per patient, triggered by SVTA and by lead dysfunction, were 74% and 98% lower, respectively, in the active than in the control group.
  
  
  CONCLUSIONS
  RM was highly effective in the long-term prevention of inappropriate ICD shocks.
authors.affiliation: Centre Hospitalier Régional Universitaire, Hôpital Cardiologique, Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guédon-Moreau
authors.forename: Claude
authors.initials: C
authors.lastname: Kouakam
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.forename: François
authors.initials: F
authors.lastname: Brigadeau
authors.forename: Stéphane
authors.initials: S
authors.lastname: Boulé
authors.forename: Hugues
authors.initials: H
authors.lastname: Blangy
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D017147:Defibrillators, Implantable; D042241:Early Diagnosis; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation*; D004556:Electric Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D058998:Remote Sensing Technology; D012307:Risk Factors; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: implantable cardioverter defibrillator; inappropriate shock; lead dysfunction; oversensing; remote monitoring; telemedicine; supraventricular tachyarrhythmias