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\begin{document}

\title{Management of Cardiac Implantable Electronic Device Follow-Up in
COVID-19 Pandemic: Lessons Learnt During Italian Lockdown}



\author[1]{Agostino Piro}%
\author[1]{Michele Magnocavallo}%
\author[2]{Domenico Della Rocca}%
\author[1]{Giovanna Manzi}%
\author[1]{Matteo Neccia}%
\author[1]{Alessia Bernardini}%
\author[1]{Marco Valerio Mariani}%
\author[1]{Martina Straito}%
\author[1]{Paolo Severino}%
\author[1]{Giuseppe Giunta}%
\author[1]{Gino Iannucci}%
\author[1]{Cristina Chimenti}%
\author[3]{Andrea Natale}%
\author[1]{Francesco Fedele}%
\author[1]{Carlo Lavalle}%
\affil[1]{Sapienza University of Rome}%
\affil[2]{Texas Cardiac Arrhythmia Institute}%
\affil[3]{St. David's Medical Center}%


\vspace{-1em}



  
  \date{May 24, 2024}


\begingroup
\let\center\flushleft
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\endgroup





\selectlanguage{english}
\begin{abstract}
Introduction: Remote monitoring (RM) has profoundly transformed the
standard of care for patients with cardiac electronic implantable
devices. It provides easy access to valuable information about
arrhythmic events, acute decompensation manifestations and
device-related issues without the need of continuous in-person visits.
Methods: Starting March 1st, 332 patients were introduced to a RM
program during the Italian lockdown in order to limit the risk of
in-hospital exposure to Severe Acute Respiratory Syndrome Coronavirus-2.
Patients were categorized in two groups based on the modality of RM
delivery {[}home (n=229) vs office (n= 103) delivered{]}. The study
aimed at assessing the efficacy of the new follow-up protocol, reported
as the mean RM Activation Time (AT) and the need for technical support
for its activation. Patients' acceptance and anxiety status was also
quantified by means of the Home Monitoring Acceptance and Satisfaction
Questionnaire and the Generalized Anxiety Disorder 7-item scale.
Results: AT time was \textless{}48 hours in 93\% of patients and 7\% of
them required further technical support. Despite a higher number of
trans-telephonic technical support in home-delivered RM group, AT was
comparable between groups (1.33\selectlanguage{ngerman}±0.83 days in home-delivered vs 1.28±0.81
days in office-delivered patients; p=0.60). Twenty-eight (2.5\%)
urgent/emergent in-person examinations were planned. High degree of
patient's satisfaction was reached in both groups while anxiety status
was higher in office-delivered group. Conclusions: RM was effective,
safe and well tolerated by patients during the Italian lockdown. Our
findings confirm the efficacy of this approach to reduce in-hospital
visits, guaranteeing patients' safety and quality of care.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Management of Cardiac Implantable Electronic Device Follow-Up in
COVID-19 Pandemic: Lessons Learnt During Italian Lockdown}

\textbf{Short title: A Novel CIED Workflow During COVID-19 Pandemic}

\textbf{Authors.} Agostino Piro, MD\textsuperscript{*}; Michele
Magnocavallo, MD\textsuperscript{*}; Domenico Giovanni Della Rocca,
MD\textsuperscript{+}; Matteo Neccia, MD\textsuperscript{*}; Giovanna
Manzi, MD\textsuperscript{*}; Marco Valerio Mariani,
MD\textsuperscript{*}; Martina Straito, MD\textsuperscript{*}; Alessia
Bernardini, MD\textsuperscript{*}; Paolo Severino,
MD\textsuperscript{*}; Gino Iannucci MD\textsuperscript{++}; Giuseppe
Giunta, MD\textsuperscript{*}; Cristina Chimenti, MD\textsuperscript{*};
Andrea Natale, MD\selectlanguage{ngerman}\textsuperscript{§}; Francesco Fedele,
MD\textsuperscript{*}; Carlo Lavalle, MD\textsuperscript{*}

\textbf{Affiliations.}

* Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology
and Geriatric Sciences, ``Sapienza'' University of Rome, Italy.

\selectlanguage{english}+ Texas Cardiac Arrhythmia Institute, St. David's Medical Center,
Austin, Texas.

\selectlanguage{english}++ Department of Translational and Precision Medicine, Sapienza
University of Rome, Italy.

SS Texas Cardiac Arrhythmia Institute, St. David's Medical Center,
Austin, Texas; Interventional Electrophysiology, Scripps Clinic, La
Jolla, California; Department of Cardiology, MetroHealth Medical Center,
Case Western Reserve University School of Medicine, Cleveland, Ohio;
Division of Cardiology, Stanford University, Stanford, California; Dell
Medical School, University of Texas, Austin, Texas.

\textbf{Disclosures:} Dr. Natale has received speaker honoraria from
Boston Scientfic, Biosense Webster, St. Jude Medical, Biotronik, and
Medtronic; and is a consultant for Biosense Webster, St. Jude Medical,
and Janssen. All other authors have reported that they have no
relationships relevant to the contents of this paper to disclose.

\textbf{Address for Correspondence:} Carlo Lavalle, MD. Department of
Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza
University of Rome, Viale del Policlinico, 155-00161 Rome, Italy. Tel:
+39335376901. E-mail address: carlo.lavalle@uniroma1.it

\textbf{Funding:} This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-profit sectors.

\textbf{Introduction:} ~Remote monitoring (RM)~has profoundly
transformed the standard of care for patients with cardiac electronic
implantable devices. It provides easy access to valuable information
about arrhythmic events, acute decompensation manifestations and
device-related issues~without the need of continuous in-person visits.

\textbf{Methods:~} Starting March 1st, 332~patients were introduced to a
RM program during the Italian lockdown in order to limit the~risk of
in-hospital exposure to Severe Acute Respiratory Syndrome
Coronavirus-2.~Patients were categorized in two groups based on the
modality of RM delivery {[}home (n=229) vs office (n= 103) delivered{]}.
The study aimed at assessing the efficacy of the new follow-up protocol,
reported as the mean RM Activation Time (AT) and the need for technical
support~for its activation. Patients' acceptance and anxiety status was
also quantified by means of the Home Monitoring Acceptance and
Satisfaction Questionnaire and~the Generalized Anxiety Disorder 7-item
scale.

\textbf{Results:} ~AT time was \textless{}48 hours in 93\% of patients
and 7\% of them required further technical support.~Despite a higher
number of trans-telephonic technical support in home-delivered RM group,
AT was comparable between groups (1.33+-0.83 days in home-delivered vs
1.28+-0.81 days in office-delivered patients; p=0.60).~Twenty-eight
(2.5\%) urgent/emergent in-person examinations were planned. High degree
of patient's satisfaction was reached in both groups while anxiety
status was higher in office-delivered group.

\textbf{Conclusions:} RM was effective, safe and well tolerated by
patients during the Italian lockdown. Our findings confirm the efficacy
of this approach to reduce in-hospital visits, guaranteeing patients'
safety and quality of care.

\textbf{Key Words:} COVID-19, Cardiac Implantable Electronic Device,
Remote Monitoring, CIED, GAD-7.

\textbf{Abbreviations:}

AF: Atrial Fibrillation

CESC: Cardiac Electrophysiology and Stimulation Center

CIED: Cardiac Implantable Electronic Device

COVID-19: COronaVIrus Disease-2019

CRT: Cardiac Resynchronization Therapy

GAD-7: Generalized Anxiety Disorder 7-item

HF: Heart Failure

HoMASQ: Home Monitoring Acceptance and Satisfaction Questionary

ICD: Implantable Cardioverter Defibrillator

ILR: Implantable Loop Recorder

IPE: In Personal Evaluation

PMK: Pacemaker

RM: Remote Monitoring

SARS-CoV2: Severe Acute Respiratory Syndrome - Coronavirus - 2

SVT: Supraventricular Tachycardia

VT: Ventricular Tachycardia

\textbf{INTRODUCTION}

In January 31, 2020, the World Health Organization declared a public
health emergency of international concern for the outbreak of the novel
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The
infection rapidly reached pandemic levels, with Veneto and Lombardy
being the first Italian Regions to be heavily affected. The steep
increasing number of coronavirus disease 2019 (COVID-19) cases led the
Italian Government to issue executive orders for virus containment on a
national level in March 11. By that date, patients with a confirmed
diagnosis of COVID-19 were about 225.000 in Italy and 7.800 in Lazio, of
which one third were in Rome (1). On a public health perspective, while
COVID-19 patients requiring professional care were congesting the
hospitals, a reorganization of healthcare service delivery, mostly
non-urgent or non-emergent ones, was deemed necessary. Yet, early
efforts were made to secure an efficient and safe elective patient care
(e.g., social distancing, mobility restrictions, use of personal
protective equipment).

Over the last decade, remote monitoring (RM) system has profoundly
transformed the standard of care for patients with cardiac electronic
implantable devices (CIEDs). RM provides access to the same information
of an in-person evaluation (IPE) via data transmission from CIEDs to
dedicated platforms easily accessible by medical staff. Mounting
evidence has confirmed its usefulness for early detection of atrial and
ventricular arrhythmias, as well as monitoring of system performance
{[}e.g., lead failure and battery depletion (2-5){]}. Additional
benefits were also demonstrated among heart failure (HF) patients in
terms of preventing unfavourable cardiovascular events and reducing
hospital readmissions (6-10).

In line with the recently issued Heart Rhythm Society indications (11),
our Cardiac Electrophysiology and Stimulation Center (CESC) revised the
pre-existing workflow for CIED patients. The cornerstone of the novel
management protocol was the improvement of RM coverage in order to
prevent any potential risk of exposure for patients and healthcare
providers, without jeopardizing quality of care. The purpose of the
present study was to report the efficacy and patient satisfaction with
the new CIED management protocol adopted during COVID-19 Italian
lockdown.

\textbf{MATERIALS~AND~METHODS}

\emph{Baseline Population and Study Period}

This single-center study was prospectively conducted at the Department
of Cardiovascular and Respiratory Diseases, Umberto I Hospital, Sapienza
University of Rome, Rome, Italy. Our study cohort included 3762
non-COVID-19 CIED patients who had been routinely followed by our
Cardiac Electrophysiology and Stimulation Services.

Baseline, clinical and device characteristics, and follow-up data were
prospectively collected in an Institutional Review Board approved
database. Patients were asked to sign an informed consent for data
collection and study participation.

\emph{CESC Workflow during COVID-19 Italian Lockdown}

Among 3762 patients with a CIED, 425 (11.4\%) patients had a single
chamber implantable cardioverter defibrillator (ICD), 528 (14.0\%) a
dual chamber ICD, 95 (2.5\%) a subcutaneous ICD in 95, 283 (7.7\%) a
cardiac resynchronization therapy (CRT) device, 231 (6.1\%) a
single-chamber pacemaker (PMK), 1472 (39.1\%) a dual-chamber PMK, and
728 (19.3\%) an implantable loop recorder (ILR). Of them, 662 (17.6\%)
patients were already in RM before COVID-19 outbreak\emph{.}

A description of the CESC workflow is depicted in Figure 1.

Patients with an IPE scheduled between March and April 2020 were
categorized into two groups: patients with a RM system prior to the
lockdown (\emph{Group wRM} ) and without a RM system (\emph{Group
w/oRM).}

\emph{-Group wRM:} Scheduled IPEs for these patients were cancelled upon
exclusion of any patient- and device-related issues assessed via a
trans-telephonic contact and a device transmission performed within a
week from the scheduled IPE appointment. For those reporting symptoms of
HF or whose latest transmission documented a problem with system
performance were followed up over the phone or, if necessary, scheduled
for IPE.

\emph{-Group w/oRM:} Patient without a RM system prior to the lockdown
were further classified upon assessment of device features and
compatibility for RM, individual clinical risk, and patient's agreement.

Patients implanted with a CIED without RM capabilities or not willing to
receive a RM system were classified by reviewing the available medical
charts and over a screening trans-telephonic contact. Two groups were
identified:

\begin{itemize}
\tightlist
\item
  ``Low-Risk'' Group:
\item
  CIED with a battery longevity \selectlanguage{english}[?] 12 months estimated during an IPE
  performed within the 6 months before study initiation;
\item
  No device alerts detected during the last IPE performed within the 6
  months before study initiation;
\item
  No history of complex arrhythmias;
\item
  No referred symptoms of acute decompensation and syncope.
\item
  ``High-Risk'' Group:
\item
  CIED with a battery longevity \textless{} 12 months estimated during
  an IPE performed within the 6 months before study initiation;
\item
  Abnormal lead impedance, threshold or sensing;
\item
  Recent history (\textless{} 3 month) of acute heart failure requiring
  hospitalization;
\item
  Appropriate and inappropriate ICD therapy detected in the last IPE;
\item
  New onset of acute decompensation symptoms or referred syncope.
\end{itemize}

For ``Low-Risk'' patients the IPE was directly postponed within 6-9
months (long-term IPE) from the original in-hospital visit. Yet, a
direct phone line with a team of specialized nurses was provided and
patients were asked to report any new symptoms, emergency room visits or
hospital admissions.

The remaining patients deemed being at ``High-Risk'' were scheduled for
an IPE to be performed the same day or within one month from their
original in-hospital examination.

Patients implanted with a CIED with RM capabilities and willing to
receive the system were further categorized into two groups on the basis
of RM system was assigned.

\emph{-Home-Delivered RM (Group hdRM):} The device manufacturer agreed
to provide the modem through a home delivery service. Once the modem was
delivered, a specialized nurse contacted the patient in order to train
and educate him/her on the use of the modem and to offer technical
support when needed. A manual transmission within 24h was requested to
verify the correct activation of the modem, and only once the patient
successfully completed the transmission, the IPE scheduled for March or
April was cancelled.

\emph{-Office-Delivered RM (Group odRM):} A short-term IPE (the same day
or within a month from the original in-hospital visit) was scheduled.
During the appointment, the RM system was delivered and a specialized
nurse was responsible for patient training and education. After
discharge, the patient was asked to perform a manual transmission from
home.

For all previous and new patients with RM, every nurse referred to a
physician for informed consent submission and patient's clinical
management. Yet, a direct phone line with a team of specialized nurses
was provided and patients were asked to report any technical issues with
the system, as well as new symptoms, emergency room visits or hospital
admissions. Compliance to drug therapy was monitored as well by phone
contacts either periodically (monthly or bimonthly based on patient's
risk profile and medical history) or in case of event recurrences.
Pharmacological therapy titration and clinical event management were
discussed among the clinical staff and, when necessary, IPE or hospital
admission were programmed according to the clinical status of the
patient. A dedicated pathway was created for IPEs in order to guarantee
patient's safety.

\emph{Patient satisfaction and anxiety status}

To evaluate the patients' acceptance and satisfaction with the RM
program, two nurses administered (within a month since the first
transmission) the Home Monitoring Acceptance and Satisfaction
Questionnaire (HoMASQ) to all new patients who received the RM system
(12). HoMASQ includes 12 items aimed at investigating five different
aspects: 1- relationship with their healthcare provider, 2- ease of use
of home monitoring technology, 3- related psychological aspects, 4-
implications on general health and 5- overall satisfaction. Each item
was rated on a five-point scale: from 0, strongly unfavourable, to 4,
strongly favourable; an answer was considered favourable with a score \selectlanguage{english}[?]
2.

Furthermore, the Generalized Anxiety Disorder 7-item (GAD-7) scale was
administered by the same nurses to all new patients in RM. GAD-7 was
administered to assess the level of safety or anxiety associated with RM
and the psychological discomfort related to the home-delivery and
office-delivery services. The questionnaire consists of seven items: 1-
feeling nervous, anxious, or on edge; 2- being able to stop or control
worrying; 3- worrying too much about different things; 4- trouble
relaxing; 5- being restless; 6- becoming easily annoyed or irritable; 7-
feeling afraid as if something awful might happen (13). Response options
are ``not at all'' (scores as 0), ``several days'' (scores as 1), ``more
than half the days'' (scores as 2) and ``nearly every day'' (scores as
3). The total score ranges from 0 to 21, with scores of 5, 10, and 15
representing the cut-off points for mild, moderate, and severe anxiety,
respectively.

\emph{Study Endpoints}

The aim of the study was to evaluate the efficacy and patient
satisfaction with the new CESC protocol adopted during COVID-19
lockdown.

The primary endpoints were: 1) ``RM Activation Time'' in \emph{Group
hdRM vs Group odRM} , defined as the time to first independent manual
transmission since modem was delivered; 2) Need for technical support
in\emph{Group hdRM vs Group odRM,} defined as the number of phone calls
or IPEs the patient required due to technical problems activating the RM
system.

The secondary endpoints were: 1) Number and type of clinically relevant
RM transmissions in the overall RM population, including CIED alerts
(battery depletion time, abnormal threshold, sensing and impedance
measurements), arrhythmic events (atrial fibrillation (AF),
supraventricular tachycardia (SVT), ventricular tachycardia (VT) and
bradycardia), ICD therapies, HF-related alerts. 2) Number of
emergent/urgent IPEs and hospitalizations; 3) Patient's acceptance and
anxiety status with the new workflow.

\emph{Statistical analysis}

Continuous data were described as mean +- SD, while median (interquartile
range) was used for abnormal data. Categorical data was described with a
number (percentage). All tests were 2-sided, and a P-value \textless{}
.05 was considered statistically significant. The statistical analysis
was performed using SPSS version 25.0 for Windows (IBM Software, Inc,
Armonk, NY).

\textbf{RESULTS}

\emph{Demographic Characteristics}

The study population included 3762 CIED patients who have been
followed-up at our Institution, 662 (17.6\%) of whom were in remote
monitoring before the COVID-19 outbreak\emph{.} Among the 3762 patients,
1114 had an IPE scheduled between March and April 2020 and were included
in the study. Baseline characteristics are summarized in Table 1.

\emph{Subgroup Characterization, RM Coverage and Distribution, and Study
Endpoint}

Among 1114 CIED patients, 265 (23.8\%) were already in RM (\emph{Group
wRM} ). RM eligibility was checked for the remaining 849 (76.2\%)
patients not in RM (\emph{Group w/oRM} ). Five hundred seventeen
(60.9\%) patients were ineligible for RM owing to connectivity or
device-compatibility issues. Therefore, individual risk assessment was
performed: a long-term IPE was scheduled for 423 (81.8\%) ``Low-Risk''
patients, whereas 94 (18.2\%) patients were deemed being at
``High-Risk'' and scheduled for a short-term IPE.

The remaining 332 patients implanted with a CIED with RM capabilities
(Table 2) were further categorized into two groups on the basis of the
modality the new RM system was assigned. In 229 (69.0\%) patients, the
modem was directly delivered home (\emph{Group hdRM)} whereas in 103
(31.0\%), modem was assigned during an in-office visit \emph{(Group
odRM).}

Starting March 1\textsuperscript{st}, 229 RM devices were shipped to
each patient's home address (\emph{Group hdRM} ). Mean delivery time was
2.8 +- 1.1 days and by March 15\textsuperscript{th} all hdRM patients had
received the modem.

In \emph{Group odRM} (n=103), an in-office visit was scheduled within an
average of 4.2 +- 1.4 days from the date of the original IPE. A dedicated
pathway was created to guarantee patient's safety. Therefore, maximum 8
patients per day were scheduled and follow-ups were carried out in two
different rooms. None of the patients, family members, or healthcare
workers being affected by the virus during the 2-month study period. By
March 27\textsuperscript{th} all \emph{Group odRM} patients had received
the device for RM.

Among the 332 patients who received the modem either at home or during
an in-office visit, RM Activation Time was \textless{}24h in 271
(81.6\%) patients, between 24h and 48h in 36 (10.8\%), between 48h and
72h in 14 (4.2\%), and \textgreater{}72h in 11 (3.3\%). RM Activation
Time within 24h was significantly lower in patients older than 75 years
old (73.2\% vs 88.2\% in patients \textless{} 75-year-old; p \textless{}
0.01) and in patients living alone (81.5\% vs 89.4\% in patients not
living alone; p \textless{} 0.01).

No significative differences in RM activation time were documented
between \emph{Group hdRM} and \emph{Group odRM} . The mean AT was 1.33 +-
0.83 days in \emph{Group hdRM} and 1.28 +- 0.81 days in \emph{Group
odRM}(p=0.60). Specifically, a first manual transmission within 24 hours
was recorded in 186 (81.2\%) patients from \emph{Group hdRM} and 87
(84.5\%) patients from \emph{Group odRM} (p=0.47; Figure 2)

However, a trend toward a higher number of trans-telephonic technical
support contacts due to problems completing the first transmission was
observed in \emph{Group odRM} {[}4 (4.2\%) patients vs 21 (9.9\%)
patients; p=0.09{]}. Moreover, 2 patients per group required a new IPE
(0.9\% vs 2\%; p=0.59); in one case a modem manufacturing defect was
detected.

\emph{Remote Monitoring Transmissions}

Number and type of clinically relevant RM transmissions in the overall
RM population are summarized in Table 3. Among new RM patients enrolled,
4365 clinically relevant RM transmissions were registered: no
significative differences in number and type of transmissions were
reported between \emph{Group hdRM} and \emph{Group odRM} (13.4 vs 13.2
transmissions/patient; p=0.18; Table 4).

Some critical alerts were recorded. Specifically, a syntomatic sinus
pause (average pause length: 5.1 +- 1.7 seconds) was found in 12 patients
with ILR: in 8 (66.7\%) a PMK was implanted, while in the other 4
(33.3\%) beta-blockers and/or amiodarone was discontinued, avoiding
IPEs. Ten ILR patients (1\%) were diagnosed with sustained episodes of
supraventricular tachycardia (SVT), 3 (30\%) of whom referring
pre-syncopal or syncopal symptoms and requiring an electrophysiological
study and radiofrequency catheter ablation. Newly diagnosed AF was
reported in 26 (2.6\%) patients: 22 (84.6\%) were contacted by phone and
prescribed with long-term oral anticoagulation according to their
CHA\textsubscript{2}DS\textsubscript{2}VASc score. Episodes of sustained
VT appropriately treated by the ICD were reported in 3 patients (0.3\%):
in two (66.7\%) cases amiodarone was added whereas catheter ablation was
performed in one (33.3\%). Increased lead impedance without threshold or
sensing changes was reported in 4 (0.4\%) patients.

Acute HF decompensation was suspected in 25 (2.5\%) patients via the
OptiVol Alert (Medtronic) or HeartLogic (Boston) indexes: 10 (40\%)
patients were managed trans-telephonically via loop diuretic titration,
7 (28\%) required hospitalization, and 8 (32\%) were scheduled for an
IPE to optimize the pharmacological therapy.

\emph{Emergent/urgent IPEs and hospitalizations}

Since the adoption of this new protocol, 230 (20.6\%) of the 1114 IPEs
scheduled for March-April were performed, 33 (3\%) of which were
urgent/emergent and required hospitalization in 24 (2.1\%) cases.
Specifically, 4 ``Low-Risk'' patients required an IPE and 3 were
admitted to the cardiology department or intensive care unit due to a
PMK pocket infection, syncope secondary to high-degree atrioventricular
block documented by the ILR requiring PMK implantation and advanced HF
unresponsive to diuretic therapy in a CRT patient. Moreover, one ``High
Risk'' patient with an ICD for primary prevention of sudden cardiac
death was admitted to intensive care unit due to electric storm.
Twenty-eight (2.5\%) of the 989 patients in RM required an
urgent/emergent IPE and 19 (1.7\%) were admitted to the hospital.
Moreover, a 78-year-old man with Advanced Heart Failure and multiple
comorbidities died from Multi Organ Failure as a consequence of
bacterial sepsis.

\emph{Patient satisfaction and anxiety status}

The HoMASQ was completed by 287 of the 332 patients (86.4\%) within 30
days from first manual activation (mean 23.4 +- 2.3 days). Similar
results were recorded in the two groups. However, a trend toward a
higher satisfaction and a better relationship with healthcare providers,
even if not statistically significant, appeared from the answers of
patients in \emph{Group odRM} . The average and standard deviation of
the five-point scale mean scores of each question and the percentage of
favourable answers (score \selectlanguage{english}[?]2) are shown in Table 5.

On the other hand, GAD-7 was administered during IPE to 297 (89.5\%)
newly enrolled RM patients in order to compare the level of anxiety
associated to different RM enrolment protocols. No anxiety status was
reported in 260 (87.5\%) patients, whereas mild, moderate, or severe
levels of anxiety were documented in 28 (9.4\%), 8 (2.7\%) and 2 (0.7\%)
of patients, respectively. Of note, a significantly higher number of
patients in \emph{Group odRM} referred a mild level of anxiety at the
time of their in-office visit compared to those of \emph{Group hdRM} at
the time they contacted the hospital to confirm receipt of the RM
device.

\textbf{DISCUSSION}

Hereby, we describe our institutional experience on the feasibility and
patient satisfaction with a novel CIED follow-up protocol during the
COVID-19 Italian lockdown. Our main findings were the following:

\begin{itemize}
\tightlist
\item
  A reorganization of follow-up workflow with transition from IPE to RM
  was easily achieved in short period of time in a large population of
  CIED patients, without jeopardizing the quality of care of our
  service;
\item
  Approximately 93\% of the patients newly introduced to RM performed
  their first manual transmission within 48 hours. Despite a trend
  toward a higher number of trans-telephonic technical support contacts
  in \emph{Group} \emph{hdRM} , RM Activation Time was similar among
  patients who received the modem at home and those whose monitor was
  delivered during an IPE.
\item
  No significant differences in number and type of transmissions were
  reported between these groups. Twenty-eight (2.5\%) urgent/emergent
  IPE were easily and safely planned in RM population when a
  trans-telephonic examination was not enough.
\item
  High degree of patient's satisfaction was reached in both groups while
  a higher anxiety status was registered when transmitter was delivered
  during an in-office visit.
\end{itemize}

Since January 2020, the steep increasing number of COVID-19 cases
worldwide has had a huge impact on public health, conditioning medical
activity and making standard, urgent, and emergent clinical management
of patients more complex. As such, a rapid reorganization of healthcare
service delivery was deemed necessary, including the in-office follow-up
for patients with a CIED. As recommended by the Heart Rhythm Society
COVID-19 Task Force (11), early efforts were made to secure an efficient
and safe elective patient care (e.g., social distancing, mobility
restrictions, use of personal protective equipment). In order to reduce
virus exposure, the cornerstone of the novel management protocol was the
improvement of RM coverage. As RM allows for transmission of data to
dedicated platforms accessible to physicians, it represented an
extremely valuable tool during the Italian COVID-19 lockdown. RM gives
access to the same information of IPEs, which may contribute to the
early detection of a wide range of arrhythmic manifestations, acute
decompensation and device-related issues (6). As reported in several
studies (9,14), RM not only plays a central role in preventing
hospitalizations, improving survival and quality of life of patients
with CIEDs, but is also a cost-effective alternative to IPEs (15). In
our experience RM allowed for an effective and safe delivery of
healthcare services. A large number of our patients was rapidly
introduced to RM, with high patient acceptance. Additionally, the
continuous technical assistance offered by our medical staff led to a
high degree of patients' compliance to the RM system; about 93\% of our
patients performed the first manual transmission within 48 hours from RM
delivery with no difference observed between \emph{Group hdRM}
and\emph{Group odRM} . Despite a longer RM Activation Time observed in
people older than 75 years and/or who live alone, all patients
successfully completed RM activation. These observations suggest that a
RM-based follow-up protocol is feasible also in elderly patients and in
those without significant in-home support (16). These subpopulations are
also at higher-risk of COVID-19-related complications and mortality, due
to a higher prevalence of comorbidities. However, RM allowed for a safe
and uninterrupted patient care, avoiding the risk of in-hospital virus
transmission.

Recent study (17), has shown a significant reduction in admissions for
acute coronary syndromes during the Italian lockdown. Despite chest pain
and other ischemia-related symptoms, many patients avoided hospital
admission due to the increased risk of virus exposure. In this context,
RM promoted a continuous patient assistance and monitoring and resulted
in being a valuable tool to identify and timely treat arrhythmic/heart
failure events, thereby avoiding potentially life-threatening
consequences. In our population, no significant differences in number
and type of transmissions were reported between \emph{Group hdRM}
and\emph{Group odRM} . Furthermore, an urgent/emergent IPE was planned
in 28 (2.5\%) patients due to arrhythmic events and 19 (1.7\%) were
admitted to the hospital.

From the psychological standpoint, the COVID-19 outbreak and the Italian
lockdown were emotionally challenging and had a serious impact on the
mental health of the entire population. In this context, we decided to
administer the HoMASQ to evaluate RM acceptance and the GAD-7
questionnaire to assess the level of anxiety associated with the new
RM-based follow-up and the modality of delivery of the modem. A high
patient satisfaction rate was documented from the HoMASQ; specifically,
patients reported an easy understanding of the device activation
process, as well as high satisfaction with the use of the transmitter
(12). Additionally, despite the ongoing pandemic and national lockdown,
patients referred a sense of security and expressed interest in
continuing with RM. Yet, GAD-7 results confirmed that SARS-CoV2 has
increased patients' level of anxiety and psychological pressure, as
confirmed in patients of \emph{Group odRM} who reported a higher rate of
anxiety associated with in-office delivery of the RM system.

\emph{Study Limitations}

Several limitations should be considered. First, this is an
observational study and carries the inherent limitations of this study
design. Second, the study reflects the experience of a single
medium-large volume Italian; therefore, generalizations should be
considered with caution, as a result of the unique scenario of the
Italian lockdown.

\emph{Conclusions}

RM was effective, safe, and highly tolerated by CIED patients during the
Italian lockdown. Our findings confirm the efficacy of this approach to
reduce in-hospital visits, guaranteeing patients' safety and quality of
care.

\textbf{Acknowledgements:} none.

\emph{}

\textbf{References}

\begin{enumerate}
\tightlist
\item
  https://coronavirus.jhu.edu/map.html 05.16.2020
\item
  Varma N, Michalski J, Epstein AE, et al. Automatic remote monitoring
  of implantable cardioverter- defibrillator lead and generator
  performance: the Lumos-T Safely RedUceS RouTine Office Device
  Follow-Up (TRUST) trial. Circ Arrhythm Electrophysiol 2010;3:428--36.
\item
  Guedon-Moreau L, Chevalier P, Marquie C, et al. Contributions of
  remote monitoring to the follow-up of implantable
  cardioverter-defibrillator leads under advisory. Eur Heart J
  2010;31:2246--52.
\item
  Varma N, Epstein AE, Irimpen A, et al. Efficacy and safety of
  automatic remote monitoring for implantable cardioverter-defibrillator
  follow-up: the Lumos-T Safely Reduces Routine Office Device Follow-up
  (TRUST) trial. Circulation 2010;122:325--32.
\item
  Capucci A, Santini M, Padeletti L, et al. Monitored atrial
  fibrillation duration predicts arterial embolic events in patients
  suffering from bradycardia and atrial fibrillation implanted with
  antitachycardia pacemakers. J Am Coll Cardiol 2005;46:1913--20.
\item
  Boehmer JP, Hariharan R, Devecchi FG, et al. A Multisensor Algorithm
  Predicts Heart Failure Events in Patients With Implanted Devices:
  Results From the MultiSENSE Study. JACC Heart Fail. 2017
  Mar;5(3):216-225.
\item
  Forleo~GB,~Tesauro M, Panattoni G, et al. Impact of Continuous
  Intracardiac ST-segment Monitoring on Mid-Term Outcomes of
  ICD-implanted Patients With Coronary Artery Disease. Early Results of
  a Prospective Comparison With Conventional ICD Outcomes. Heart. 2012
  Mar;98(5):402-7.
\item
  Forleo GB, Panattoni G, Schirripa V, et al. Device monitoring of heart
  failure in cardiac resynchronization therapy device recipients: a
  single-center experience with a novel multivector impedance monitoring
  system. J Cardiovasc Med, 14(10),726--732.
\item
  Boehmer JP, Hariharan R, Devecchi FG, et al. A Multisensor Algorithm
  Predicts Heart Failure Events in Patients With Implanted Devices:
  Results From the MultiSENSE Study. JACC Heart Fail. 2017
  Mar;5(3):216-225.
\item
  Della Rocca DG, Albanese M, Placidi F, et al. Feasibility of automated
  detection of sleep apnea using implantable pacemakers and
  defibrillators: a comparison with simultaneous polysomnography
  recording. J Interv Card Electrophysiol. 2019 Dec;56(3):327-333.
\item
  Lakkireddy DR, Chung MK, et al. Guidance for Cardiac Electrophysiology
  During the Coronavirus (COVID-19). Pandemic from the Heart Rhythm
  Society COVID-19 Task Force; Electrophysiology Section of the American
  College of Cardiology; and the Electrocardiography and Arrhythmias
  Committee of the Council on Clinical Cardiology, American Heart
  Association. HeartRhythm 2020.
\item
  Ricci RP, Morichelli L. Workflow, time and patient satisfaction from
  the perspectives of Home Monitoring. Europace (2013)15,i49--i53.
\item
  Spitzer RL, Kroenke K, Williams JBW, Lowe B. (2006).~A Brief Measure
  for Assessing Generalized Anxiety Disorder. Archives of Internal
  Medicine, 166(10),1092.
\item
  Hindricks G, Taborsky M, Glikson M, et al. Implant-based
  multiparameter telemonitoring of patients with heart failure
  (IN-TIME): a randomised controlled trial. Lancet 2014;384:583--590.
\item
  Crossley GH. Further evidence that remote monitoring is
  cost-effective: it's time for all to adopt. HeartRhytm 2017;14:58.
\item
  Artico J, Zecchin M, Zorzin Fantasia A, et al. Long-term Patient
  Satisfaction With Implanted Device Remote Monitoring: A Comparison
  Among Different Systems. J Cardiovasc Med 2019 Aug;20(8):542-550.
\item
  De Filippo O, D'Ascenzo F, Angelini F, et al. Reduced rate of hospital
  admissions for ACS during Covid-19 outbreak in northern Italy. N Engl
  J Med.
\end{enumerate}

\textbf{FIGURE LEGENDS}

\textbf{Figure 1: CIED management protocol adopted during COVID-19
Italian lockdown.} CIED = Cardiac Implantable Electronic Device, Group
hdRM = RM home delivered, Group odRM = RM in office delivered, IPE = In
Personal Evaluation, RM = Remote Monitoring.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure 2: Remote Monitoring Activation Time in Group hdRM and
Group odRM.} Group hdRM = RM home delivered, Group odRM = RM in office
delivered.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

\end{center}
\end{figure}

\textbf{Figure 3: GAD-7 results comparing in Group hdRM and Group
odRM.}GAD-7 = Generalized Anxiety Disorder 7-item, Group hdRM = RM home
delivered, Group odRM = RM in office delivered.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image3/image3}

\end{center}
\end{figure}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Demographics\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
All patients (n=1114)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group wRM (n=265)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group w/oRM (n=849)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
p-value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Age, yrs\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
64.5 \selectlanguage{ngerman}± 18.4\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
63.3\selectlanguage{ngerman}±17.9\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
64.2\selectlanguage{ngerman}±18.3\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.74\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Male, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
638 (57.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
149 (56.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
489 (57.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.69\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{CIED}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
ICD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
429 (38.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
100 (37.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
329 (38.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.76\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Single Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
228 (20.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
57 (21.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
171 (20.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.37\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Dual Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
177 (15.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
34 (12.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
143 (16.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.09\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
S-ICD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
24 (2.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
9 (3.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
15 (1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.22\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
PM, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
425 (38.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
102 (38.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
323 (38.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.89\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Single Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
61 (5.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
18 (6.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
43 (5.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.28\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Dual Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
364 (32.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
84 (31.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
280 (33.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.28\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
ILR, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
171 (15.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
35 (13.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
136 (16.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.27\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
CRT, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
89 (8.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
19 (7.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
70 (8.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.57\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Heart Disease}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
No, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
101 (9.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
25 (9.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
76 (8.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.81\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Ischaemic HD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
451 (40.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
95 (35.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
356 (41.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.08\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Valvular HD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
116 (10.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
24 (9.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
92 (10.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.41\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Channelopathies, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
12 (1.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
2 (0.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
10 (1.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Congenital HD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
7 (0.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1 (0.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
6 (0.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Others, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
22 (2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
5 (1.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
17 (2.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
NYHA\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
I, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
278 (25.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
63 (23.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
215 (25.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.61\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
II, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
473 (42.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
117 (44.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
356 (41.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.52\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
III, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
330 (29.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
78 (29.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
252 (29.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
IV, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
33 (2.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
7 (2.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
26 (3.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.73\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
LVEF {[}range{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
46 \selectlanguage{ngerman}± 12 {[}20 -- 60{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
44 \selectlanguage{ngerman}± 11 {[}20 -- 60{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
45 \selectlanguage{ngerman}± 12 {[}20 -- 60{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.81\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Comorbidities}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Diabetes mellitus, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
413 (37.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
101 (38.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
312 (36.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.69\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Chronic Obstructive Pulmonary Disease, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
187 (16.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
40 (15.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
147 (17.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.40\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Hypertension, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
601 (53.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
146 (55.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
455 (53.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.67\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Chronic Kidney Disease, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
231 (20.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
52 (19.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
179 (21.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.61\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{TABLES}

\textbf{Table 1. Baseline characteristics of study population
(N=1114).}CRT = Cardiac Resynchronization Therapy, Group wRM = patients
in RM prior to the lockdown, Group w/oRM = patients without a RM system,
HD = Heart Disease, ICD = Implantable Cardioverter Defibrillator, ILR =
Implantable Loop Recorder, LVEF = Left Ventricular Ejection Fraction,
NYHA = New York Heart Association, PMK = Pacemaker, S-ICD = Subcutaneous
Implantable Cardioverter Defibrillator.\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Demographics\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Patients RM enrolled (n=332)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group hdRM (n=229)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group odRM (n=103)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
p-value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Age, yrs\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
64.2 \selectlanguage{ngerman}± 17.4\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
63.8 \selectlanguage{ngerman}± 17.2\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
65.5 \selectlanguage{ngerman}± 18.0\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.67\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Male, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
196 (59.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
135 (58.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
61 (59.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{CIED}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
ICD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
131 (39.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
90 (39.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
41 (39.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Single Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
56 (16.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
37 (16.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
19 (18.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.60\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Dual Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
58 (17.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
40 (17.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
18 (17.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
S-ICD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
17 (5.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
13 (5.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
4 (3.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.49\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
PM, n \%\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
129 (38.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
89 (38.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
40 (38.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Single Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
20 (6.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
13 (5.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
7 (6.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.69\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Dual Chamber, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
109 (32.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
76 (33.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
33 (32.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.84\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
ILR, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
53 (16.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
37 (16.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
16 (15.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.89\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
CRT, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
19 (5.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
13 (5.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
6 (5.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Heart Disease}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
No, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
33 (9.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
23 (10.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
10 (9.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Ischaemic HD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
127 (38.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
89 (38.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
38 (36.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.73\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Valvular HD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
36 (10.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
23 (10.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
13 (12.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.48\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Channelopathies, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
5 (1.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
3 (1.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
2 (2.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Congenital HD, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
2 (0.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1 (0.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1 (1.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Others, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
7 (2.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
5 (2.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
2 (2.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
NYHA\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
I, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
90 (27.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
63 (27.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
27 (26.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.81\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
II, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
146 (43.9)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
99 (43.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
47 (45.6)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.68\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
III, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
87 (26.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
60 (26.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
27 (26.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
IV, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
9 (2.8)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
7 (3.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
2 (2.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
LVEF {[}range{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
45 \selectlanguage{ngerman}± 12 {[}20 -- 60{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
44 \selectlanguage{ngerman}± 12 {[}20 -- 60{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
47 \selectlanguage{ngerman}± 12 {[}20 -- 60{]}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.43\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{Comorbidities}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Diabetes mellitus, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
123 (37.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
87 (38.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
36 (35.0)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.60\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Chronic Obstructive Pulmonary Disease, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
54 (16.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
40 (17.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
14 (16.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.38\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Hypertension, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
174 (52.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
123 (53.7)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
51 (49.5)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.48\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Chronic Kidney Disease, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
67 (20.2)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
46 (20.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
21 (20.4)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2. Baseline characteristics of patients enrolled in RM
adopting new CESC protocol (N=332).} CRT = Cardiac Resynchronization
Therapy, Group wRM = patients in RM prior to the lockdown, Group w/oRM =
patients without a RM system, HD = Heart Disease, ICD = Implantable
Cardioverter Defibrillator, ILR = Implantable Loop Recorder, LVEF = Left
Ventricular Ejection Fraction, NYHA = New York Heart Association, PMK =
Pacemaker, S-ICD = Subcutaneous Implantable Cardioverter Defibrillator.

\textbf{Table 3. Number and type of clinically relevant RM
transmissions.} AHRE = Atrial High Rate Episode, CIED = Cardiovascular
Implantable Electronic Devices, ICD = Implantable Cardioverter
Defibrillator, RM = Remote Monitoring, SVT = SupraVentricular
Tachycardia, VT = Ventricular Tachycardia.\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
Overall RM population (n=989)\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
New RM enrolled (n=332)\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
P-value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Transmissions, n\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
13157\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
4365\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Transmission Type\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
CIED parameters problems, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
26 (0.2)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
8 (0.2)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.86\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
AHRE, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
10502 (79.8)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
3473 (79.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.72\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
SVT, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
442 (3.4)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
137 (3.1)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.48\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
VT, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
79 (0.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
16 (0.4)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.07\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
ICD Shock, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
7 (0.1)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2 (0.1)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Bradycardia, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
1750 (13.3)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
596 (13.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.55\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Symptoms, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
263 (2.0)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
107 (2.4)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.07\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Heart failure monitoring, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
88 (0.7)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
26 (0.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.61\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
Group hdRM (n=229)\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
Group odRM (n=103)\strut
\end{minipage} & \begin{minipage}[b]{0.22\columnwidth}\raggedright\strut
P-value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Transmissions, n\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3043\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
1322\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
Transmission Type\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
CIED parameters problems, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
6 (0.2)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2 (0.2)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
AHRE, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2357 (79.8)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
1017 (79.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.70\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
SVT, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
96 (3.4)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
41 (3.1)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
VT, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
11 (0.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
5 (0.4)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
ICD Shock, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2 (0.1)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0 (0.1)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Bradycardia, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
423 (13.3)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
173 (13.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.47\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Symptoms, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
74 (2.0)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
33 (2.4)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.89\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
Heart failure monitoring, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
18 (0.7)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
8 (0.6)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
1\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 4. Number and type of clinically relevant transmissions in
patients enrolled in RM adopting new CIED protocol.} AHRE = Atrial High
Rate Episode, CIED = Cardiovascular Implantable Electronic Devices,
Group hdRM = RM home delivered, Group odRM = RM in office delivered, ICD
= Implantable Cardioverter Defibrillator, SVT = SupraVentricular
Tachycardia, VT = Ventricular Tachycardia.\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
ITEM DESCRIPTION\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group hdRM (n=216)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group hdRM (n=216)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group odRM (n=71)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
Group odRM (n=71)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Favourable responses \%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Favourable responses \%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Relationship with healthcare provider\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Relationship with healthcare provider\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Relationship with healthcare provider\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Relationship with healthcare provider\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Relationship with healthcare provider\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Was the explanation of RM system exhaustive?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.04 \selectlanguage{ngerman}± 0.82\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
95\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.15 \selectlanguage{ngerman}± 0.87\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
90\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
During the contacts have you received clear information?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.97 \selectlanguage{ngerman}± 0.80\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
94\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.75 \selectlanguage{ngerman}± 0.89\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
89\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Easiness of use of this new technology\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Easiness of use of this new technology\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Easiness of use of this new technology\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Easiness of use of this new technology\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Easiness of use of this new technology\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
How was it simple to connect and turn on the transmitter?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.19 \selectlanguage{ngerman}± 0.73\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
96\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.87 \selectlanguage{ngerman}± 0.85\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
91\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
How was simple to assure transmissions?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.27 \selectlanguage{ngerman}± 0.76\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
95\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.96 \selectlanguage{ngerman}± 0.86\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
90\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Psychological aspects related to remote control\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Psychological aspects related to remote control\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Psychological aspects related to remote control\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Psychological aspects related to remote control\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Psychological aspects related to remote control\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
How much did the transmitter affect your daily activity?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.05 \selectlanguage{ngerman}± 0.88\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
91\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.05 \selectlanguage{ngerman}± 0.86\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
92\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Did you ever feel observed by the transmitter?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.17 \selectlanguage{ngerman}± 0.86\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
96\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.1 \selectlanguage{ngerman}± 0.80\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
95\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Does the transmitter provide you a sense of security?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.89 \selectlanguage{ngerman}± 0.82\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
92\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.06 \selectlanguage{ngerman}± 0.84\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
93\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Is the transmitter a bother?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.28 \selectlanguage{ngerman}± 0.79\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
93\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.14 \selectlanguage{ngerman}± 0.85\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
93\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Implication of RM on general health\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Implication of RM on general health\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Implication of RM on general health\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Implication of RM on general health\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Implication of RM on general health\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
How much important was the information for physician?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.3 \selectlanguage{ngerman}± 0.75\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
95\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.94 \selectlanguage{ngerman}± 0.92\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
90\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Do you think that HM had positive effects on your health?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.09 \selectlanguage{ngerman}± 0.81\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
95\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.87 \selectlanguage{ngerman}± 0.89\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
91\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Overall satisfaction of RM\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Overall satisfaction of RM\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Overall satisfaction of RM\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Are you satisfied of RM organization?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.08 \selectlanguage{ngerman}± 0.75\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
95\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.91 \selectlanguage{ngerman}± 0.84\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
93\%\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Do you want to continue to use RM technology?\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.42 \selectlanguage{ngerman}± 0.79\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
96\%\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.29 \selectlanguage{ngerman}± 0.87\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
91\%\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 5. HoMASQ results.} Group hdRM = RM home delivered, Group
hoRM = RM in office delivered, HoMASQ = Home Monitoring Acceptance and
Satisfaction Questionary.

\selectlanguage{english}
\FloatBarrier
\end{document}

