Relationship between ICD implantation volume and treatment parameters of patients receiving an ICD with remote monitoring

Abstract

BACKGROUND:

Both highly specialized heart centres and less specialized hospitals care for patients with implantable ICDs/CRT-Ds with remote monitoring.

OBJECTIVE:

To investigate potential differences in patient treatment according to centre’s ICD implantation volume.

METHODS:

Based on their 2012 ICD/CRT-D implantation volume, centres enrolled in the NORDIC ICD trial in Germany were assigned to one of three groups: high- (HV, $n=$ 345), medium- (MV, $n=$ 340) or low-volume (LV, $n=$ 189).

RESULTS:

The HV-centres had a significant higher CRT-D proportion (41.7%; LV: 36.5%; MV: 23.2%; $P_{\text{𝑔𝑙𝑜𝑏𝑎𝑙}}<$ 0.001), significant shorter median procedure duration (49 min; MV: 58 min; LV: 60 min; $P_{\text{𝑔𝑙𝑜𝑏𝑎𝑙}}<$ 0.001) but significant longer median hospital stay (4 days; MV and LV: 3 days; $P_{\text{𝑔𝑙𝑜𝑏𝑎𝑙}}<$ 0.001) compared to MV- and LV-centres. The X-ray exposure was shorter in MV/HV-centres (MV: 3.4 min; HV: 3.6 min; LV: 5.5 min; $P_{\text{𝑔𝑙𝑜𝑏𝑎𝑙}}<$ 0.001). Only 3.5% (LV: 2.6%; HV: 3.5%; MV: 4.1%) patients received at least one delivered inappropriate shock and 2.5% (HV: 2.0%; LV: 2.6%; MV: 2.9%) patients had withheld inappropriate ICD shocks without subsequent inappropriate shock delivery within 24.5 months of median follow-up.

CONCLUSION:

Implantation volume-dependent differences were observed in the device selection, procedure duration and x-ray exposure duration. Remote monitoring in combination with adequate response pattern prevented imminent inappropriate shocks in all three groups.