Utility of remote monitoring for implantable device controls in the phase 1 of the first wave of COVID 19 pandemic

ABSTRACT

Backgrond During the first outbreak of COVID 19 pandemic, Piacenza was particularly affected since it counted over one hundred daily access in emergency department, of patients (pz) with SARS COV2 virus. This fact led to a reorganization of hospital activity consisting in the formation of 7 department devoting COVID 19 care and in temporarily postponing scheduled activities of various disciplines to prevent the spread of virus. Also Our Division of cardiology has kept only urgent clinical and interventional activity. With the use of remote monitoring (RM), we were able to check implantable cardiac devices (ICD) almost scheduled and we called ICD recipients in office only for urgent troubles. Methods: In our study we evaluated all ICD recipients that had a scheduled follow up in our electrostimulation clinic on the period from 23th February 2020 to 18 th May 2020 Results: In office scheduled controls during the period considered, involved 216 patients. 85% out of them was followed also with MR;after postponing in office visits, we requested control transmissions. In total we received 441 scheduled and with alert transmissions. Regarding alert transmission 3 of them signaled ERI (elective replacement indicator), so the replacement of device has been planned;3 of them indicated noise in Ventricular Fibrillation zone related to lead malfunction, so we planned reimplantation of new ventricular lead;12 recorded ventricular arrhythmias (only one patient was called to visit in office for recurrent ventricular arrhythmias);1 of them signaled long lasting atrial fibrillation so we called him to begin anticoagulant therapy. We performed phone triage before confirming in office visit. None of the scheduled transmissions detected troubles. Only 1,8% of patients followed by remote monitoring came in hospital in that period. Conclusions: RM during phase 1 of the first wave of COVID 19 outbreak allowed us to reduce in office visits and to call in hospital only patients with real needs, decreasing the spread of the virus and maintaining identification of clinical and technical troubles.