Remote monitoring with implantable cardiac monitors (ICMs) may provide important value when treating MI patients who present with cardiac autonomic dysfunction, according to a new study published in The Lancet Digital Health.
Researchers examined data from 1,305 patients who were treated from May 2016 to July 2020. Seventy-six percent of patients were men, and the median age was 64 years old.
In the analysis, 400 high-risk patients with a median left ventricular ejection fraction of 45% were randomly assigned to either receive an ICM that was remotely monitored or receive normal care.
During the median follow-up period of 21 months, serious arrhythmic events were detected in 30% of patients in the ICM group compared with 6% of patients in the control group
The cumulative detection rates for the ICM group and control group were 18.9% vs. 2.7% after six months, 25% vs. 4% after 12 months and 49% vs. 11% at the end of the study.
Meanwhile, in the intervention group, index arrhythmias first detected included atrial fibrillation (AFib) six minutes or longer in 43 patients, atrioventricular block IIb or higher in ten patients, fast non-sustained ventricular tachycardia in three patients, and sustained ventricular tachycardia or ventricular fibrillation in four of the patients.
When looking at the control group, on the other hand, index arrhythmias first detected were AFib six minutes or longer in 11 patients and sustained ventricular tachycardia or ventricular fibrillation in just one of the patients.
The authors also noted that, among ICM patients, 41 (68%) of the 60 serious arrhythmic episodes were categorized as asymptomatic compared to seven (58%) of the 12 among control patients.
Overall, the authors wrote, improvements in detection was noticed for all types of serious arrhythmic episodes.
“Our study has important clinical implications,” wrote lead author Axel Bauer, MD, a specialist at Medical University of Innsbruck in Austria, and colleagues. “Early detection of subclinical but prognostically relevant serious arrhythmic events by ICMS warrants close follow-up and careful evaluation for diagnostic and therapeutic measures, including optimization of medical therapy.”
Monitoring high-risk patients so closely with ICMs, the team concluded, "provides a new opportunity for personalized treatment decisions."
Read the full study here.