Currently, a remote monitoring system is recommended for more effective monitoring of patients with implanted cardioverter defibrillators (ICDs).

OBJECTIVE

To analyze the feasibility of remote monitoring system for prediction of ventricular tachyarrhythmias in patients with ICD.

MATERIAL AND METHODS

The study included 104 patients (69 men/35 women), aged 60±15 years with ischemic (n=73) or non-ischemic cardiomyopathy and sustained VT (n=86) throughout the follow-up period (median 41 months). We retrospectively assessed the following parameters 1, 2 and 4 weeks, as well as 3 months before each episode of VT using remote monitoring system: daily activity, mean heart rate, heart rate variability (SDNN), percentage of atrial and ventricular pacing, non-sustained and/or sustained (>30 sec) episodes of VT, atrial fibrillation and episodes of anti-tachycardia pacing/electroconvulsive therapy. Univariate, ROC and multivariate analyses identified the following parameters of remote monitoring system associated with VT: VT ≤180 beats/min and so-called «fast VT/VF» (VT >180 beats/min or ventricular fibrillation). The control group included patients without arrhythmic events (n=80).

RESULTS

VT type had no significant relationship with age and gender of patients, etiology of cardiomyopathy, antiarrhythmic therapy and follow-up, as well as parameters of remote monitoring system. Predictors of any VT: 1) ICD therapy within the last 3 months; 2) non-sustained VT over the past 3 months; 3) non-sustained VT over the past 7 days; 4) nighttime heart rate increase by more than 5 beats per minute during the last 7 days; 5) SDNN variations over the last 7 days. Identification of 3 out of 5 signs made it possible to predict VT with accuracy of 82% (sensitivity 90%, specificity 76%).

CONCLUSION

We developed an algorithm for prediction of VT using remote monitoring system. These results can be used for timely prescription or correction of antiarrhythmic and other therapy.