title: Role of Automatic Wireless Remote Monitoring Immediately Following ICD Implant: The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) Trial.
abstract: BACKGROUND
  The incidence of unscheduled encounters and problem occurrence between ICD implant and first in-person evaluation (IPE) recommended at 12 weeks is unknown. Automatic remote home monitoring (HM) may be useful in this potentially unstable period.
  
  
  RESULTS
  ICD patients were randomized 2:1 to HM enabled post-implant (n = 908) or to conventional monitoring (CM; n = 431). Groups were compared between implant and prior to first scheduled IPE for IPE incidence, causes, and actionability (reprogramming, system revision, medication changes) and event detection time. HM and CM patients were similar (mean age 63 years, 72% male, LVEF 29%, primary prevention 73%, DDD 57%). In the post-implant interval assessed (HM 100 ± 21.3 days vs. CM 101 ± 20.8 days, P = 0.54), 85.4% (776/908) HM patients and 87.7% CM (378/431) patients had no cause for IPE (P = 0.31). When IPE occurred, actionability in HM (64/177 [36.2%]) was greater versus CM (15/62 [24.2%], P = 0.12). Actionable items were discovered sooner with HM (P = 0.025). Device reprogramming or lead revision was triggered following 53/177 (29.9%) IPEs in HM versus 9/62 (14.5%) in CM (P = 0.018). Arrhythmia detection was enhanced by HM: 276 atrial and ventricular episodes were detected in 135 follow-ups in contrast to CM (65 episodes at 17 IPEs). More silent arrhythmic episodes were discovered by HM (7.2% vs. 1.5% [P = 0.15]). Since 27/42 (64.3%) IPEs driven by HM alerts were actionable, event notification was a valuable method for problem detection. Importantly, HM did not increase incidence of non-actionable IPEs (P = 0.72).
  
  
  CONCLUSIONS
  Activation of automatic remote monitoring should be encouraged soon post-ICD implant.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Niraj
authors.initials: N
authors.lastname: Varma
authors.affiliation: Department of Cardiology, University of Pennsylvania, Pennsylvania, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Epstein
authors.affiliation: Department of Cardiology, Akron General Hospital, Ohio, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.affiliation: Biotronik, Lake Oswego, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Michalski
authors.affiliation: Department of Cardiology, New York University Langone Medical Center, New York, New York, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Love
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000639:trends; D011446:Prospective Studies; D059015:Wireless Technology
keywords: defibrillators; follow-up; patient monitoring; remote monitoring