Automatic remote monitoring utilizing daily transmissions: transmission reliability and implantable cardioverter defibrillator battery longevity in the TRUST trial
Automatic remote monitoring utilizing daily transmissions: transmission reliability and implantable cardioverter defibrillator battery longevity in the TRUST trial
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DOI：
10.1093/europace/eux059
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发表时间：
2018-04-01
期刊：
影响因子：
6.1
通讯作者：
Epstein, Andrew E.
中科院分区：
文献类型：
--
作者：
Varma, Niraj;Love, Charles J.;Epstein, Andrew E.
植入式心律转复除颤器（ICD）患者的自动远程家庭监护（HM）的益处可能需要高传输频率。然而，传输可靠性和对电池寿命的影响仍然不确定。我们假设HM将具有高传输成功率，允许基于指南的随访，并改善电池寿命。这是测试在前瞻性随机TRUST trial.Methods和结果植入式心律转复除颤器患者随机植入后2：1 HM（n = 908）（每天传输）或传统的人监测[常规管理（CM），n = 431（HM禁用）]。在两组中，每3个月安排5次评估，持续15个月。通过接收的传输与可能的总传输以及由于错过传输而失败的预定HM检查的数量来评估家庭监控技术性能。使用连续传输的数据，比较了植入后15个月时HM与CM的电池寿命，并再次比较了植入后3年HM的电池寿命。每位患者的传输成功率为91%（中位随访时间为434天）。总体而言，在潜在的363 450天（87%）中，每天收到HM传输315 795。在HM中，只有55/3759（1.46%）的不成功计划评价归因于传输丢失。HM与CM的电击频率和起搏百分比相似。HM的15个月电池寿命高出12%（93.2 +/- 8.8% vs. 83.5 +/-6.0%CM，P < 0.001）。在HM患者的延长随访中，估计电池寿命为50.9 +/- 9.1%（中位数52%），在36 months.Conclusion自动远程HM表现出强大的传输可靠性。可以在不减少电池寿命的情况下维持日常传输负载。家庭监控可保护电池寿命并跟踪长期设备性能。
Aims Benefits of automatic remote home monitoring (HM) among implantable cardioverter defibrillator (ICD) patients may require high transmission frequency. However, transmission reliability and effects on battery longevity remain uncertain. We hypothesized that HM would have high transmission success permitting punctual guideline based follow-up, and improve battery longevity. This was tested in the prospective randomized TRUST trial.Methods and results Implantable cardioverter defibrillator patients were randomized post-implant 2:1 to HM (n = 908) (transmit daily) or to Conventional in-person monitoring [conventional management (CM), n = 431 (HM disabled)]. In both groups, five evaluations were scheduled every 3 months for 15 months. Home Monitoring technology performance was assessed by transmissions received vs. total possible, and number of scheduled HM checks failing because of missed transmissions. Battery longevity was compared in HM vs. CM at 15 months, and again in HM 3 years post-implant using continuously transmitted data. Transmission success per patient was 91% (median follow-up of 434 days). Overall, daily HM transmissions were received in 315 795 of a potential 363 450 days (87%). Only 55/3759 (1.46%) of unsuccessful scheduled evaluations in HM were attributed to transmission loss. Shock frequency and pacing percentage were similar in HM vs. CM. Fifteen month battery longevity was 12% greater in HM (93.2 +/- 8.8% vs. 83.5 +/- 6.0% CM, P < 0.001). In extended follow-up of HM patients, estimated battery longevity was 50.9 +/- 9.1% (median 52%) at 36 months.Conclusion Automatic remote HM demonstrated robust transmission reliability. Daily transmission load may be sustained without reducing battery longevity. Home Monitoring conserves battery longevity and tracks long term device performance.