Digital health in the electrophysiological lab: Initial experience, safety and feasibility using remote support for arrhythmia ablation-Results of REMOTE-VA study
Authors: Botezat B I , Popescu S S , Heeger C H , Vogler J , Eitel C , Phan H L , Mamaev R , Kirstein B , Kuck K H , Tilz R R 
Published: May 2024

Abstract

Background
In most electrophysiology (EP) labs, electroanatomical mapping (EAM) systems are operated on site by qualified staff or field technical engineers (FTE). Due to lack of skilled personnel, the FTE usually must travel between different hospitals and procedures must be planned in advance. Ablation of ventricular arrhythmias (VA) represents the most complex procedure in the field. The use of remote support (RS) to guide complex EP procedures has the potential to increase flexibility, reduce travel times and maximise healthcare resources.

Purpose
To evaluate the safety and feasibility of RS as compared to on-site support guided catheter ablation procedures for VA.

Methods
All patients undergoing ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation using remote support were included. The electronical system of the hospital was searched for 30 days postprocedural emergency department (ED) visits, unplanned ambulatory presentations, and readmissions. RS guided three-dimensional (3D) mapping was achieved by connecting the EAM software with an integrated audio-visual solution for remote support. Internet connection-based headphones and high-resolution cameras ensured the communication between the operator and the FTE, who worked exclusively from home office. The control group consisted of an equal number of patients matched for the type of procedure and undergoing on-site guided procedures. All ablations were performed using high density 3D mapping, as per institutional standard.

Results
Between October 2022 and October 2023, a total of 25 patients underwent VT (32%) or PVC ablation in our centre using RS and were compared to 25 patients undergoing the same procedures under on-site guidance. In the RS group one patient underwent epicardial VT ablation and another one bipolar ablation for VT Storm. The demographic data were similar between the groups.
The median procedure time was 120 (93, 143) minutes in the RS group and 112 (95, 138) minutes in the control group (p=0.95), while the fluoroscopy time was 11.4 (7.0, 14.0) and 7.26 (5.0, 10.9) minutes respectively (p=0.08). The procedural success was achieved in 96% procedures in the RS group and in 100% in the control group. No technical issues or changes to on-site support were reported.
One minor intraprocedural complication was noted among the control patients, while 24% of the patients in each group developed minor complications until discharge. Two patients in the RS group and one in the control group had ED visits, while only one patient in the control group had an unplanned ambulatory presentation. One unplanned readmission was reported in the control group (Table 1).

Conclusions
Even in the most complex procedures including epicardial ablation, the use of RS was feasible and safe in this single centre study. This approach has the potential to increase the feasibility in case of emergency procedures, reduce travel times, and maximise healthcare resources.