Diagnosis of atrial fibrillation by means of implantable devices. The role of remote monitoring

Atrial fibrillation (AF) is responsible for most hospitalizations for arrhythmia and is an independent risk factor for stroke. The cardioembolic stroke is frequently related to the presence of AF in any form (paroxysmal, persistent, permanent) and is characterized by high mortality and high residual disability. The clinical history of patients implanted with PM / ICD is often characterized by new occurrence or the recurrence of AF. We evaluated the role of remote monitoring of implanted devices for accurate detection of symptomatic or silent AF especially when there is an atrial electrode. Out of the 3876 patients followed in our laboratory, 699 (18%) were managed through remote monitoring systems. Automatic alerts of the remote monitoring systems were set to early detect and track AF episodes by using algorithms capable of measuring the daily burden, the length and frequency of AF episodes and the ventricular response in some device models. Transmissions (about 96,OOO/year), are evaluated, assessing the severity of the alarms, for the optimal therapy management with a workload of 435 and 87 hours/year for nurses and cardiologists respectively. Ambulatory examinations were reduced by 9.9% and also mean time dedicated to each patient was significantly reduced.