TELEMONITORING IN PREDICTING ADVERSE EVENTS DURING EARLY FOLLOW UP IN PATIENTS WITH IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR (ICD)
Introduction: Telemonitoring is considered as an useful method to monitor not only proper function of implanted devices but also several clinical parameters. In this study we aimed to evaluate the prognostic value of various parameters received from telemonitoring in predicting adverse events (AE) defined as ventricular arrhythmias (VT/ VF) and /or death in patients after ICD implantation.
Methods: This study included 25 patients (mean age 65 ± 11yrs) with ischemic cardiomyopathy who received ICD for primary prevention. The following parameters obtained via telemonitoring were analyzed: number of premature ventricular contractions (PVC/h), mean heart rate at rest (MHR), heart rate variability (SDANN), patient activity (% Pact) and percentage of atrial arrhythmia (% AFB). All parameters were evaluated on the 1st day (1D) after implantation and as the mean of the first 30 days of observation (av30D). Additionally, in patients who experienced AE during FU we evaluated trend of change in these parameters (data obtained at 30th, 14th and 7th day before AE).
Results: Patients were followed for avg 215 ± 83 days. The AE occurred in 4 patients (16%). Among studied parameters only SDANN values differentiated patients with (group B) and without (group A) AE during a FU. Group B had significantly lower values SDANN assessed either at 1D (32 vs 70 ms, p <0.05) or as the av30D (49 vs 72ms, p <0.05). Trend analysis of parameters assessed on 30th, 14th, and 7th day before AE showed an increase in mean of PVC/h and a decrease in MHR, SDANN, % Pact (Figure 76.1).
Conclusions: SDANN values differentiated patients with and without AE during the 1-year follow-up. Decrease in SDANN, % Pact, MHR and increase PVC/h can be observed during 30 days preceding AE, therefore trend in this parameters should be analyzed while interpreting data from telemonitoring.
Figure 76.1. Changes in selected parameters transmitted via telemonitoring during 30 days before adverse event in a patient with ICD.