title: Potential role of antitachycardia pacing alerts for the reduction of emergency presentations following shocks in patients with implantable cardioverter-defibrillators: implications for the implementation of remote monitoring.
abstract: OBJECTIVE
  Despite increased use of remote monitoring (RM) to follow up implantable cardioverter-defibrillator (ICD) recipients, many patients still receive ICD shocks in the community and present to the emergency department. Our aim was to identify the best predictors of impending shock delivery that can be measured with an ICD and to identify the most appropriate activities to alert physicians to during RM follow-up.
  
  
  RESULTS
  All patients presenting to our institution for ICD shock, from November 2011 to November 2014, were enrolled in this prospective study. Patient characteristics, investigation results, and details of electrical activities from ICD interrogation were recorded at presentation. Presentations were classified as potentially avoidable if activities from a list of set criteria were apparent more than 48 h before index shock. Univariate and multivariate analyses were then used to identify predictors of potentially avoidable shocks. In total, 109 emergency presentations were recorded in 90 patients (male: 85%; 57 ± 16 years; ischaemic cardiomyopathy: 49%; LVEF: 34 ± 13%; electrical storm: 40%), of which 26 (24%) were potentially avoidable. Antitachycardia pacing (ATP) episodes were the most important predictor of impending shock. Potentially avoidable shocks were preceded by more episodes of ATP than unavoidable shocks (13 [3-67] vs. 3 [0-10]; P < 0.001). Patients followed up with RM systems configured to generate alerts following ATP delivery experienced significantly less ICD shocks (24 vs. 16%, P < 0.01).
  
  
  CONCLUSIONS
  Remote monitoring systems that generate alerts following ATP delivery could reduce emergency presentations for ICD shock by 24%, as ATP is a key predictor of impending shock delivery.
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France stephane.boule@chru-lille.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Boulé
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.
authors.forename: Sandro
authors.initials: S
authors.lastname: Ninni
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Finat
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.|National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Botcherby
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Kouakam
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.|Faculty of Medicine, University of Lille 2, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Brigadeau
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.|Faculty of Medicine, University of Lille 2, Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.|Faculty of Medicine, University of Lille 2, Lille, France.
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guédon-Moreau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005602:France; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D058998:Remote Sensing Technology; D017180:Tachycardia, Ventricular / Q000628:therapy*; D017216:Telemedicine; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
keywords: Alerts; Antitachycardia pacing; Implantable cardioverter-defibrillator; Remote monitoring; Shock; Telemedicine