Remote Monitoring of Cardiac implantable Electronic Devices: Characterisation of Clinical Burden, Use in Arrhythmia Detection, and Impact on Patient Outcomes

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dc.contributor.advisorMiddeldorp, Melissa
dc.contributor.advisorHendriks, Jeroen
dc.contributor.advisorCampbell, Kevin (Health First Medical Group, Florida, USA)
dc.contributor.authorO'Shea, Catherine Jane
dc.contributor.schoolAdelaide Medical School
dc.date.issued2024
dc.description.abstractRemote monitoring (RM) has evolved to become the standard of care in the follow-up of patients with cardiac implantable electronic devices, facilitating access to data regarding device function and patient events in between routine in-person clinic follow-up. This thesis addresses logistical challenges associated with RM, its use in heart rhythm monitoring, and its impact on clinical outcomes in patients with an implantable cardioverter defibrillator (ICD). As RM has been more broadly adopted, device clinics have been inundated with RM transmissions and the associated challenges associated with managing RM data, which can include both clinically significant information, and irrelevant device downloads or alerts. Chapter 2 describes the volume of RM transmissions in a population of over 26,000 CIED patients, characterising alerts as high- and lower-acuity. Chapter 3 further expands on the burden of RM, with an assessment of alerts in a cohort of 1470 patients with an implantable loop recorder. Of more than 14,000 alerts transmitted during a 12-month period, 59.8% were deemed to be false-positive ie. not consistent with a true arrhythmia. Clinical atrial fibrillation (AF) is a known risk marker for ischaemic stroke, and often necessitates anticoagulation for stroke prevention, depending on individual patient risk profile according to the CHA2DS2-VASc score. Previously, the risk of stroke in subclinical/device-detected AF and the associated benefit of anticoagulation has been unclear, with variability in written guidelines. Through RM, Chapter 4 explores the occurrence of device-detected AF episodes of at least 6 hours in 7651 patients population with either a pacemaker, defibrillator, or loop recorder in situ, and monitored their anticoagulation status. Of the 1704 patients with a device-detected AF episode of at least 6 hours in duration, and a CHA2DS2-VASc score of ≥2, 63.1% were not receiving anticoagulation. The COVID-19 pandemic was a unique time in the 21st century, with unprecedented lockdowns and widespread community uncertainty. Previous dramatic world events including natural disasters and high-intensity sporting events have been associated with a rise in ventricular arrhythmias. In Chapters 5 and 6, we use RM to explore the occurrence of both atrial and ventricular arrhythmias during the early pandemic. Chapter 5 paradoxically demonstrated a significant decline in ventricular arrhythmias in ICD when compared with the same time period one year prior, while Chapter 6 established an increase in atrial fibrillation in patients with an ICD or pacemaker. The most substantial benefits of RM have been seen in ICD patients. In Chapter 7, we assess the impact of RM on clinical outcomes in ICD patients via a systematic review and meta-analysis including 14 randomised controlled trials comparing RM of ICDs versus in-person follow-up. While RM resulted in significantly fewer patients receiving inappropriate ICD shocks, there was no difference in cardiovascular hospitalisation or all-cause mortality.
dc.description.dissertationThesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2024en
dc.identifier.urihttps://hdl.handle.net/2440/144126
dc.language.isoen
dc.provenanceThis electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legalsen
dc.subjectremote monitoring
dc.subjecthome monitoring
dc.subjectremote transmission
dc.subjectremote interrogation
dc.subjectdevice alerts
dc.subjectcardiac implantable electronic device
dc.subjectpacemaker
dc.subjectimplantable cardioverter defibrillator
dc.subjectdefibrillator
dc.subjectimplantable loop recorder
dc.subjectatrial fibrillation
dc.subjectanticoagulation
dc.subjectstroke
dc.subjectventricular arrhythmia
dc.subjectventricular tachycardia
dc.subjectventricular fibrillation
dc.subjectCOVID-19
dc.subjectcoronavirus
dc.titleRemote Monitoring of Cardiac implantable Electronic Devices: Characterisation of Clinical Burden, Use in Arrhythmia Detection, and Impact on Patient Outcomes
dc.typeThesisen

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