Real-world use of insertable cardiac monitor remote programming

Abstract Background Insertable cardiac monitors (ICMs) for continuous arrhythmia monitoring generate high transmission volumes and adds considerable workload for clinics. The novel LUX-Dx™ (Boston Scientific, MA, USA) ICM allows remote reprogramming of device alert settings, potentially reducing the need for in-office visits. This study aimed to characterize the real-world use of remote reprogramming during its initial commercialization in Europe and to assess its impact on ICM transmission burden. Methods De-identified data were collected from 506 patients (58% male, mean age 63±19 years) across 20 European centers. The primary indications for ICM were syncope (268 patients, 53%) and suspected atrial fibrillation (68 patients, 13%). Results Patients were followed for a median of 7 months [IQR: 4-11]. Over this period, 12,692 device transmissions were received (3.4 per patient-month). Alert transmissions accounted for 65% (8,290), scheduled transmissions for 30% (3,829), patient-initiated interrogations for 4% (481), and clinician-initiated interrogations for 1% (92). Transmission rates varied by indication, from 2.0 per patient-month for suspected atrial fibrillation to 5.0 per patient-month for palpitations. A total of 287 reprogramming events occurred in 153 ICMs (2.5 per patient-year among those reprogrammed), with 101 events (35%) performed remotely. Within 30 days post-insertion, 18% [95% CI: 14-21] of ICMs were reprogrammed. The time to first reprogramming varied by clinical indication (see Figure). A paired analysis showed a median transmission rate reduction of 23% after reprogramming (P<0.001). Conclusions In this initial experience with the LUX-Dx™ ICM, transmission volume during follow-up was manageable and closely associated with the patient's clinical profile. The transmission burden could be reduced by approximately 30% by eliminating scheduled transmissions, following an alert-based strategy, as recommended by recent remote monitoring guidelines. Reprogramming reduced transmission review workload by 23%, and the remote reprogramming feature—currently used in 35% of cases—holds potential for broader adoption to optimize device management. This function could enhance workflow efficiency and ease resource demands for both clinics and patients by reducing the need for in-office visits.