Impact of remote monitoring on reducing the burden of inappropriate shocks related to implantable cardioverter-defibrillator lead fractures: insights from a French single-centre registry.
OBJECTIVE
Lead fractures in implantable cardioverter-defibrillator (ICD) patients may cause inappropriate shocks (ISs). An early diagnosis is essential to prevent adverse clinical events. Implantable cardioverter-defibrillator remote monitoring (RM) permits prompt detection of lead fracture. Limited data define the impact of RM on ISs specifically related to lead fracture. We sought to compare the number of ISs related to lead fracture in patients with vs. without RM follow-up.


RESULTS
We checked the registry of our institution and collected, between July 2007 and June 2014, 115 cases of right ventricular lead fractures. All relevant data were documented from patients' files, device-interrogation printouts and electronic records, and remote transmissions databases when applicable. We assessed the ISs that were related to lead fracture. The first study endpoint was the number of ISs per shocked patient. Among the 82 patients with conventional follow-up (CFU) and the 33 patients with RM, a first IS occurred to 32.9% (n = 27) and 30.3% (n = 10, P = 0.83) of the patients, respectively. Shocked patients in the RM group underwent significantly fewer ISs with a mean of 6 ± 2 shocks per patient [median of 3.5 shocks (2-8)] than those in the CFU group with a mean of 18 ± 5 shocks per patient [median of 10 shocks (5-22), P = 0.03].


CONCLUSIONS
Remote monitoring helps to reduce the burden of ISs related to ICD lead fractures.
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France zouheir.souissi@dbmail.com.
Zouheir
Z
Souissi
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Laurence
L
Guédon-Moreau
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Stéphane
S
Boulé
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Claude
C
Kouakam
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Loïc
L
Finat
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Christelle
C
Marquié
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
François
F
Brigadeau
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Ludivine
L
Wissocque
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Stéphanie
S
Mouton
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France Faculté de Médecine Pôle Recherche Amphi J et K, INSERM U1011, Lille 2 University, Lille 59045, France.
David
D
Montaigne
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Didier
D
Klug
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Salem
S
Kacet
Department of Cardiovascular Medicine, Lille University Hospital, Boulevard du Professeur Leclercq, Lille Cedex 59037, France.
Dominique
D
Lacroix
D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D058998:Remote Sensing Technology
Defibrillators; Follow-up; Inappropriate shock; Lead fracture; Remote monitoring