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Remote Device Monitoring — EECC MCQ

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ModerateCardiac DevicesRemote Device MonitoringEECC

A 60-year-old man with an ICD for primary prevention (ischaemic cardiomyopathy, LVEF 30%) undergoes remote device monitoring. The transmission shows 3 episodes of non-sustained VT (longest run 12 beats at 180 bpm) and lead impedance within normal limits. No therapies were delivered. Battery longevity is estimated at 4 years. What is the most appropriate response?

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Correct answer: C — Review the episodes during a routine or brought-forward clinic visit; consider adding or optimising anti-arrhythmic therapy and beta-blocker dose

Remote monitoring has become the standard of care for ICD follow-up (ESC Class IIa recommendation), allowing early detection of arrhythmias, lead issues, and battery status without requiring in-person visits. NSVT episodes in ischaemic cardiomyopathy are clinically significant: they may predict future sustained VT and ICD therapies. While not an emergency, these episodes warrant clinical review (brought-forward if frequent or symptomatic), optimisation of medical therapy (beta-blocker up-titration, consideration of amiodarone), and potentially electrophysiology assessment if NSVT burden increases. Simply ignoring NSVT or deactivating therapy zones would be inappropriate.

Reference: ESC (2022): Guidelines on VA and SCD Prevention; HRS Expert Consensus on Remote Monitoring