Effect of daily remote monitoring on pacemaker longevity: A retrospective analysis

BACKGROUND Energy demand of remote monitoring in cardiac implantable electronic devices has never been investigated. Biotronik Home Monitoring (HM) is characterized by daily transmissions that may affect longevity. OBJECTIVE The aim of the study was to retrospectively compare longevity of a specific dual-chamber pacemaker model in patients with HM on and patients with HM off. METHODS Hospital files of 201 patients (mean age 87 +/- 10 years, 78 men) who had received a Biotronik Cylos DR-T pacemaker between April 2006 and May 2010 for standard indication were reviewed. In 134 patients (67%), HM was activated. The primary end point was device replacement due to battery depletion. RESULTS The median follow-up period was 56.4 months (inter-quartile range 41.8-65.2 months). The estimated device longevity was 71.1 months (95% confidence interval [CI] 69.1-72.3 months) in the HM-on group and 60.4 months (CI 55.9-65.1 months) in the HM-off group (P < .0001). The frequency of inhospital visits with significant device reprogramming was higher in the HM-on group than in the HM-off group (33.3% vs 25.0%, respectively; P = .03). Lower ventricular pulse amplitude (2.3 +/- 0.4 V vs 2.7 +/- 0.5 V; P < .0001) and pacing percentage (49% +/- 38% vs 64% +/- 38%; P = .02), both calculated as time-weighted averages, were observed with HM on as compared with HM off. Patient attrition was significantly lower in the HM-on group (9.7%; 95% CI 3.0%-28.7%) than in the HM-off group (45.6%; 95% CI 30.3%-64.3%) (P < .0001). CONCLUSION In normal practice, energy demand of HM, if present, was overshadowed by programming optimization likely favored by continuous monitoring. Pacemakers controlled remotely with HM showed an 11-month longer longevity. Patient retention was superior.