Digital health in the EP lab: evaluating the safety and feasibility of routine implementation of remote access and technical support in complex ablation procedures - results of the REMOTE study

Abstract Background Complex ablation procedures are conducted using three-dimensional (3D) electroanatomical mapping (EAM) systems, which are typically operated on-site by field technical engineers (FTE). Due to shortage of skilled personnel, FTEs often need to travel between different hospitals, necessitating advance scheduling of procedures. To address this, remote access (RA) and technical support were introduced to increase the flexibility of electrophysiological procedures and optimize the use of healthcare resources. (1) Methods This is a prospective, single centre, observational study. Consecutive patients undergoing RA-based ablation procedures between September 2022 and September 2024 were included and analysed for demographic data, procedural characteristics, and periprocedural adverse events. The EAM systems were controlled exclusively remotely by FTE working from home office, utilizing an integrated audio-visual RA solution. There was no on-site support available. Results A total of 269 patients were enrolled in the study (age 67 (57, 75) years, 40.5% females, BMI 26.8 (23.8, 30.1) kg/m2). Regarding the procedure, 166 (61.7%) patients underwent atrial fibrillation ablation (38.0% of them with additional cavotricuspid isthmus (CTI) ablation and 1.8% of them with additional supraventricular tachycardia (SVT) ablation), 12 (4.5%) CTI ablation, 25 (9.3%) an SVT ablation, 3 (1.1%) an atrioventricular node ablation, 1 (0.4%) ablation for premature atrial contractions, and 9 (3.3%) electrophysiological studies without ablation. Importantly, 12.6% patients underwent premature ventricular contractions (PVC) ablation and 7.1% ventricular tachycardia ablation (21.1% of them epicardial, 5.3% electrical storm). The median procedure duration was 141.5 (109.8, 169.3) minutes. The median number of radiofrequency (RF) applications was 63 (20.5, 108.5), with a median RF time of 13.5 (6.3, 21.1) minutes. The median fluoroscopy time and dose were 9.1 (5.8, 12.9) minutes and 380.0 (204.0, 629.0) cGy*cm2 respectively. The median amount of contrast medium was 40.0 (20.0, 50.0) ml. A median of 11000 (7000, 15000) IE heparin was administered, while protamine was used in 29 (10.8%) patients, with a median of 7000 (4500, 7000) IE. There was one need to change to on-site support due to an operator error after a software update of the RA system. Major adverse events were reported in 2.6% of patients, while 5.9% of them had minor adverse events, none of them related to the RA system (Table1). The travel burden for the FTE was reduced with 47 798 km, leading to an estimated reduction of CO2 emissions with 15.7 tones. Conclusion This is the largest study to date reporting on the routine implementation of RA for complex catheter ablation procedures. The approach was found to be safe and feasible, with the potential to enhance flexibility, reduce travel times for FTE, and optimize the use of healthcare resources. Additionally, it can contribute to improved treatment quality.Table 1.Periprocedural complications