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.