Perspective:

Several nonrandomized studies found a substantial benefit of remote ICD monitoring in terms of mortality, but two of the three Biotronik randomized trials (TRUST and ECOST) mostly failed to confirm this. Only IN-TIME showed a significant positive effect of remote monitoring on the composite clinical score and on all-cause mortality. Notably, none of the individual trials was designed or powered to show a survival advantage. In addition to the potential hard endpoint benefit of reduced mortality, other benefits include earlier notification of hardware malfunction, clinical events like appropriate therapy and onset of atrial fibrillation, reductions in hospital use, and better adherence to follow-up. One should not assume that different proprietary systems may result in similar results, especially when it comes to the endpoint which drove the majority of the benefit—heart failure worsening. Multiparameter, automatic, and daily monitoring appears more advantageous than other platforms.