Interpretation:

The results of the current trial indicate that daily remote monitoring is noninferior to three monthly office visits for safety at 24 months, with a significant reduction in inappropriate and total ICD shocks. This was also associated with an increase in battery longevity. Cost-effectiveness analyses are awaited. These calculations will need to factor in the resources required for daily review of information from these devices for all patients being followed versus any improvements in ICD performance.

Remote monitoring has gained increased attention in the past few years, with a promise to streamline care for patients receiving ICD implantation. Studies indicate that of all patients undergoing routine follow-up visits, only about 10% result in a clinically actionable episode, such as programming changes. Currently, home/remote monitoring is available for most companies, each with a slightly different nuance to its functioning. Medtronic has its CareLink Network, Guidant/Boston Scientific its Latitude Patient Management system, St. Jude Medical its Medical Housecall Plus system, and Biotronik its Home Monitoring System, which was tested in this trial. The latter was also recently studied in the TRUST trial in the United States, where remote monitoring was done every 3 months rather than daily, as in this trial. One interesting observation in that trial was that there was a large delay in clinician evaluation of first arrhythmic event in both routine and remote monitoring groups, with significant variation between centers (ranging from days to weeks). Similarly, despite not requiring routine clinic follow-up, there was a nonadherence rate of about 15% in the remote monitoring arm. These and other issues such as telecommunication failures will need to be addressed before remote monitoring can be routinely advocated for patients undergoing ICD implantation.