Remote Control of Cardiac Implantable Electronic Devices: Exploring the New Frontier—First Clinical Application of Real-time Remote-control Management of Cardiac Devices Before and After Magnetic Resonance Imaging

The purpose of the present study was to evaluate the performance of remote-control (RC) management of cardiac implantable electronic devices (CIEDs) in clinical practice using a new service model in patients undergoing magnetic resonance imaging (MRI) scans. The number of CIEDs is constantly growing, alongside the demands for prompt checks. Although remote CIED interrogation exists, ultimately, real-time remote management is the goal. In this study, patients with MRI-conditional devices suitable for RC interaction who required an MRI were enrolled. An onsite technician began the RC session by contacting the remote operator, applying the programmer wand, and keying in an access code. The device was remotely checked via encrypted Wi-Fi by an electrophysiologist using a laptop. An MRI-safe mode was programmed per a preestablished proprietary algorithm. Following the scan, patient devices were remotely reinterrogated and reprogrammed to baseline, with adjustments made as clinically necessary. Patients subsequently were asked to complete a survey. Ultimately, a total of 100 RC CIED reprogrammings were performed in 50 MRI sessions, prescan and postscan. The average RC time interaction was four minutes prescan and three minutes postscan, respectively. No complications occurred. Five patients had more than one MRI in this study and 15 patients had had previous MRIs. In eight patients, baseline settings were reprogrammed. Most patients (82%) were very satisfied, preferring device specialist remote management. Only 14 (32%) patients used home remote monitoring. In conclusion, RC management of CIEDs in the MRI setting is feasible, safe, and clinically relevant. Use of the MRI mode determination algorithm was safe, consistent, and efficient. Expanding RC in CIED management for service anytime, anywhere is the next challenge.