Exploring Optimal Cardiac Electronic Implantable Devices Programming: Reducing Non-Actionable Alerts and Assessing Clinical Outcomes.

BACKGROUND: The rapid evolution of cardiac implantable electronic devices (CIEDs) has increased remote transmission data, leading to excessive non-actionable alerts (NAA) and alert fatigue.

OBJECTIVE: Optimize alert parameters to minimize NAA and evaluate the impact on clinical outcomes.

METHODS: We included 536 participants (mean age 75 (15) years, 60.4% male, 83.4% white) with CIEDs. In 413 patients, CIEDs were reprogrammed to censor alerts as follows: atrial fibrillation (AF) episodes < 5.5 h, persistent AF > 1 month with prior alerts, AF < 24 h on anticoagulation or with prior appendage occlusion, and non-sustained ventricular tachycardia (NSVT) in defibrillator platforms. NAAs were tracked 90-days pre- and post-reprogramming. Incident ischemic stroke and sudden cardiac death (SCD) were assessed over a median 1.8-year follow-up. Logistic regression models examined associations between reprogramming and outcomes.

RESULTS: Reprogramming was implemented for AF alerts (69.5%, n = 287) and NSVT alerts (30.5%, n = 126). After reprogramming, NAAs significantly decreased from 6.68 (SD = 10.02) to 2.27 (SD = 4.58), p < 0.001. During follow-up, ischemic stroke rates in AF patients were similar between reprogrammed (5.2%, n = 15) and control groups (5.4%, n = 5). In those with NSVT alerts, SCD incidence was lower in reprogrammed (2.3%, n = 3) versus controls (9.3%, n = 3). In logistic regression models adjusted for demographics, CHA₂DS₂VASC score, anticoagulation status, and prior stroke history, there was no statistically significant difference in stroke risk between groups (OR 0.82 [0.27-2.51]).

CONCLUSIONS: Guideline-based alert parameters in CIED patients significantly reduced NAA burden with no increasing in adverse outcomes in patients with device-detected AF or NSVT alerts. This approach may reduce noise and safely improve efficiency.