Methods and Results
Before the COVID-19 pandemic, only patients implanted with a loop
recorder (ILR) and patients implanted with an implantable cardioverter
defibrillator (ICD) or a cardiac resynchronization therapy (CRT) device
were given the possibility to have default RM. Conversely, only a
minority of patients implanted with a pacemaker (PM) were on RM.
Historically, patients with ICDs and CRTs were evaluated in our device
clinic twice a year and patients with PMs once a year, whether or not
they had a RM system at home. Conversely, ILR patients were followed
exclusively with RM without routine in-person visits.
During the COVID-19 pandemic (March 2020-February 2021) the strategy of
our center was to implement RM for all compatible CIEDs, in order to
reduce in-person visits. Patients already in possession of a RM system
were not seen in the device clinic anymore and were followed exclusively
from home. During the study period, 100% of newly implanted devices
received RM at the time of the implantation procedure: 82 ILR, 194 PMs,
80 ICDs/CRTs. This was a significant increase compared to the same
months of 2019, when only 68% of patients received RM at the time of
device implantation (106/106 ILR, 83/203 PMs, 78/82 ICD/CRTs;
p<0.01). In addition, 502 patients implanted before March 2020
with RM compatible devices and not in possession of a RM system were
contacted to receive the transmitter. A specific pathway was created to
limit patient-to-patient interaction. A dedicated EP nurse contacted the
patients by phone to perform an interview to screen for signs and
symptoms of possible COVID-19 infection. If negative, the patient was
scheduled to present to the device clinic to sign the RM consent form.
Appointment slots were 30 minutes apart to avoid patients’ interaction.
Upon arrival in clinic, body temperature was measured, and a health
screening form was filled and registered. The device was checked by an
electrophysiologist only if the patient was due for his usual follow-up
appointment (12 months since the prior follow-up for PMs, 6 months for
ICDs/CRTs). For selected device types having the RM function programmed
as ON by default, the RM monitoring transmitter was just handed over to
the patient or mailed at home the following day and the patient was able
to activate the system and initiate a transmission on his own or with
the help of the technical support over the phone. For a minority of
patients, the device-RM transmitter coupling was performed in-office.
Scheduled transmissions were then organized every 3 months. In case of
symptom onset (tachycardia, dizziness, syncope, chest pain, etc.), the
patients were instructed to send an urgent manual transmission and
contact the device clinic. None of the patients with RM was routinely
seen in clinic anymore, not even at the time of the alleged 6-month or
12-month appointment. By the end of February 2021, a total of 1676
patients have been remotely monitored at our Institution. This greatly
reduced semiannual and annual in-person visits (potential saving of 1683
visits/year), which translates into a significant reduction in patients’
potential exposure to COVID-19.