Usefulness of remote monitoring for the early detection of back-up mode in implantable cardioverter defibrillators

Reversion of an implantable cardioverter defibrillator (ICD) to back-up mode degrades the operating capabilities of the device, puts patients at risk and requires rapid intervention by a manufacturer's technician. To illustrate the usefulness of remote monitoring of ICDs for the early detection of reversion to back-up mode. In our centre, all patients implanted with an ICD, with or without resynchronisation, were offered remote monitoring as soon as the technology became available. Alerts triggered by the remote monitoring system were included prospectively in a register. During a mean follow-up of 5.7±1.3 years, a total of 1594 patients with an ICD (441 with resynchronisation function) followed with remote monitoring were included in the register. Among 15,874 alerts, only 10 were related to a reversion to back-up mode. Among those, seven reversions were caused by radiotherapy, two were fake events and one was caused by magnetic resonance imaging. Except for the two fake events, the eight other patients had an emergency admission for the resetting and reprogramming of their ICD. None of the reversion to back-up mode alerts was followed by a clinical alert (i.e. a shock alert) before the ICD problem was resolved. Reversion to back-up mode is a very rare event, accounting for 0.06% of total alerts; remote monitoring facilitates the early detection of this critical event to resolve the problem faster than the next scheduled follow-up. Remote monitoring can prevent serious damage to the patient and avoids systematic ambulatory control of the ICD after each radiotherapy session. La réversion d’un défibrillateur automatique implantable (DAI) en mode de secours dégrade les capacités de fonctionnement de l’appareil, engendre un risque pour les patients et nécessite une intervention rapide du technicien du fabricant. Cette étude montre l’utilité de la télésurveillance des DAIs dans la détection précoce des réversions en mode secours. Dans notre centre, tous les patients implantés d’un DAI, avec ou sans resynchronisation, ont reçu un système de télésurveillance dès que cette technologie a été disponible. Toutes les alertes déclenchées par le système de télésurveillance sont prospectivement incluses dans un registre. Durant un suivi moyen de 5,7±1,3 ans, un total de 1594 patients implantés d’un DAI (441 avec système de resynchronisation) et suivis par télésurveillance ont été inclus dans ce registre. Parmi 15 874 alertes, seulement 10 correspondaient à une réversion