title: Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes.
abstract: BACKGROUND
  Remote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up.
  
  
  OBJECTIVE
  This study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up.
  
  
  METHODS
  Electronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up.
  
  
  RESULTS
  In the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002).
  
  
  CONCLUSIONS
  Meta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Perdana University-Royal College of Surgeons in Ireland, Serdang, Malaysia.
authors.forename: Nirmalatiban
authors.initials: N
authors.lastname: Parthiban
authors.affiliation: University of South Australia, Adelaide, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Darragh J
authors.initials: DJ
authors.lastname: Twomey
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Pathak
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Lau
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Roberts-Thomson
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Young
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: aganesan@gmail.com.
authors.forename: Anand N
authors.initials: AN
authors.lastname: Ganesan
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000592:standards; D004554:Electric Countershock / Q000379:methods* / Q000592:standards; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D058998:Remote Sensing Technology / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome
keywords: home monitoring; mortality; shock; sudden cardiac death