NEW: Prof Matteo Bertini’s comment on this edition of the ClinicalEVIDENCE newsletter:
Matteo Bertini, M.D, PhD, FAIAC
Professor of Cardiology, Head of EP lab, Cardiological Center, Sant’ Anna University Hospital
“Recently, the Guidelines on the Practical Management of Remote Device Clinics pave the way for correct use by optimizing resources. From the Multitude register in Italy we are doing quite well but we can do better. By analyzing more than 6000 CIEDs in 26 Italian centers we confirmed that outpatient interrogations are being reduced in favor of remote interrogations, but adherence to RM guidelines is still not optimal and problems with connectivity and scheduled transmissions remain. However, the right path seems to have been taken and in the near future we will see important reorganizations in the cardiology staff. Delve into the Newsletter to learn more.”
Summary
This edition of Clinical Evidence explores the latest original data presented at the EHRA Congress in Berlin (7-9 April 2024). The first abstract, already available as a full-length paper, analyses the association between HeartLogic™ and biventricular pacing in CRT-D patients.¹ Recent findings from the pooled analysis of the SMART-AV and SMART-CRT trials are detailed.² Insights into two abstracts concerning remote monitoring in clinical practice are provided. The focus of the first abstract is on S-ICD programming and SMART pass activation³, while the second provides an overview of the utilisation and programming of remote monitoring for CIEDs in practical clinical settings⁴. The last abstracts delve into real-world data regarding the good acceptance of the extrathoracic therapy⁵ and the safety related to the replacement procedure.⁶
Key Takeaways
- HeartLogic Algorithm and Biventricular Pacing: Maintaining optimal BiV pacing is crucial to prevent HF exacerbation. The HeartLogic alert, early detecting the HF worsening as consequence of BiV% reduction, facilitate the optimisation of the Biv% and avoid the HF worsening.¹
- SmartDelay Clinical Benefit: Results of Pooled Analysis: SmartDelay may provide clinical benefit to CRT patients with prolonged interventricular delay (≥ 70 ms).²
- Remote Monitoring in Clinical Practice: From a picture of current clinical practice, captured through remote monitoring system, it can be observed that most S-ICD patients have SMART Pass enabled during follow-up and this is associated with significantly lower rates of detected and treated arrhythmias.³ Remote monitoring is still suboptimal in Italian clinical practice: solutions are needed to enhance patient enrollment, ensure continuous patient connectivity, and reduce the burden of non-actionable transmission, implementing an alert-based strategy.⁴
- S-ICD Performance in Real-World Practice: Improved acceptance was observed in patients who underwent SAPB, highlighting the significance of enhanced patient implantation experience for long-term outcomes.⁵ The S-ICD replacement, often an opportunity to optimise the generator’s position, is a safe and easy to perform procedure.⁶
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