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.