Heart rhythm management optimisation of pacemaker recipients using remote monitoring: the HERO registry.

Introduction: Current expert consensus recommends remote monitoring (RM) for cardiac implantable electronic devices (CIEDs). As this recommendation is primarily based on studies involving implantable cardioverter defibrillators (ICDs), the HERO (HEart Rhythm management Optimisation of pacemaker recipients using remote monitoring) study aimed to reinforce this recommendation for pacemaker recipients.

Methods: The exploratory, retrospective, single-centre HERO study included 203 patients with an increased stroke risk (CHA₂DS₂-VASc score ≥ 2) but without a history of atrial fibrillation or flutter, who received a pacemaker between January 2016 and April 2018. Occurrence and detection time of atrial and ventricular arrhythmias were analysed in patients with RM (RM+; n = 60) and those without RM (RM-; n = 143), together with CIED adverse events, cardiology visits and anticoagulation adjustments.

Results: The median age of the patients was 80 (73-85) years, with 55.2% being men. During a median follow-up of 5.0 years, 53.7% were diagnosed with at least one arrhythmic event (RM+ 60.0% vs RM- 51.0%, p = 0.28). The median time from pacemaker implantation to detection of first arrhythmic event was 2.5 (0.5-8.2) years in the RM+ group versus 2.8 (1.2-8.0) years in the RM- group (hazard ratio 0.89; 95% confidence interval 0.59-1.35; p = 0.58). There were no differences in the number of adverse events or anticoagulation adjustments during follow-up. More CIED telephone consultations were conducted in the RM+ group.

Conclusion: A substantial proportion of pacemaker patients experienced one or more arrhythmic events during follow-up. The HERO study did not demonstrate a difference in time to detection of the first event when using remote monitoring.