Reorganizing the device clinic: remote monitoring of cardiac implantable
electronic devices during the COVID-19 pandemic
Abstract
COVID-19 pandemic has caused a necessary reorganization of the elective
outpatient device clinic. Remote monitoring (RM) of cardiac implantable
electronic devices (CIEDs) has been validated as a safe and effective
tool to follow patients, limiting the need for in-person visits. We
provided a snapshot of the current clinical practice in a tertiary
electrophysiology center in Italy, suggesting a potential model of care
for patients with CIEDs. Before the COVID-19 pandemic, patients with
implantable cardioverter defibrillators/cardiac resynchronization
therapy (ICD/CRTs) were evaluated in the device clinic twice a year and
patients with pacemakers (PMs) once a year; loop recorder (ILR) patients
were followed remotely only. In the COVID-19 period RM was implemented
for all compatible CIEDs. Patients with RM were not seen in clinic
anymore and were followed with RM. In the COVID-19 period, 100% of
newly implanted devices received RM (82 ILR, 194 PMs, 80 ICDs/CRTs),
compared to 68% in the same months of 2019 (106/106 ILR, 83/203 PMs,
78/82 ICD/CRTs), p<0.01. Moreover, 502 previously implanted
patients with RM compatible devices were contacted and received RM. By
the end of February 2021, 1676 patients were remotely monitored at our
Institution, with a potential saving of outpatient visits of 1683
visits/year, against an average of 8514 RM transmissions/year needing
evaluation. RM of CIEDs is essential to reduce in-person visits during
the COVID-19 pandemic. The potential for elective outpatient
appointments reduction has to be counterbalanced by the sustainability
of a large number of transmissions and data to analyze.