key: cord-0830989-p3nfgnbp
authors: Malanchini, Giovanni; Malacrida, Maurizio; Ferrari, Paola; Senni, Michele; De Filippo, Paolo
title: Remote Monitoring of Respiratory Pattern in an ICD Patient With COVID-19 Pneumonia
date: 2021-05-05
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2021.03.012
sha: b86091fae05973b1a67a54233ce9414514530ed6
doc_id: 830989
cord_uid: p3nfgnbp

A 67-year-old man with history of heart failure developed dyspnea. In this report, we describe an increase in his device-detected respiratory rate. Monitoring respiratory rate is recommended for evaluating acute cardiac decompensation, but such an algorithm could also be used to diagnose episodes of pneumonia caused by severe acute respiratory syndrome-coronavirus-2 infection. (Level of Difficulty: Intermediate.)

I mplantable devices, including implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and pacemakers (PPMs), enable continuous measurement of clinical variables and access to patients' data via remote monitoring systems. It remains unclear whether such technologies could provide useful insights into coronavirus disease-2019 (COVID-19)Àrelated infections because no clinical experience has yet been reported.

We report the case of a patient who tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and who was implanted with an ICD (AUTOGEN X4 cardiac resynchronization therapy defibrillator; Boston Scientific, St. Paul, Minnesota) equipped with respiratory rate trend (RRT), a diagnostic algorithm for continuous respiratory rate (RR) monitoring and followed-up with the LATITUDE (Boston Scientific, St. Paul, Minnesota) remote monitoring system.

A 67-year-old man with a history of hypertension, diabetes, permanent atrial fibrillation, and myocardial infarction developed signs and symptoms of COVID-19 and was admitted to the hospital in March 2020.

He was treated with acetaminophen, azithromycin, hydroxychloroquine, and oxygen supplementation with a nasal cannula and a Venturi mask. His symptoms began to resolve in the second week of the hospital stay, and he was discharged on April 11. As depicted in Figure 1 , there was an increase in the device-detected RR from an average of 17 respirations/ min recorded on the first day of symptom onset to a peak of 22 respirations/min, recorded 2 to 3 days after admission. RRT continued to show values higher than average during the recovery phase, whereas the patient continued to receive oxygen, and RRT reached its nadir before discharge. Mind the Respiratory Trend -2 0 2 1 : --urgencies in a new setting (1) . Device-based continuous monitoring of a patient's derived parameters could be helpful for diagnostic and prognostic evaluation of clinical conditions after device implantation, thereby potentially improving the remote clinical management of patients with cardiac devices (e.g., ICDs, CRT, or PPMs), especially during the ongoing pandemic.

Recent reports have highlighted the substantial decrease in activity level recorded through continuous monitoring of cardiac devices as an important phenomenon during the COVID-19 pandemic (2) . In the past decade, cardiac devices capable of measuring the RRT have been developed. In the MultiSENSE (Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients) study, the novel HeartLogic algorithm for heart failure monitoring (Boston Scientific), which combines data from multiple device-based sensors and includes RRT function, was implemented. Notably, this index proved to be a sensitive and timely predictor of impending heart failure decompensation (3) . Although monitoring RR is recommended by international guidelines primarily for evaluating acute decompensation, such an algorithm could also be useful to evaluate episodes of a sudden increase in RR, a potential sign of respiratory illness, such as pneumonia caused by SARS-

The case provided a first step in elucidating how data derived from continuous and remote monitoring of relevant variables could help an uneventful situation; we reported a potential new application for the detection of possible new COVID-19 infections.

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

ADDRESS FOR CORRESPONDENCE: Dr. Giovanni Malanchini, Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Bergamo, Italy. E-mail: gmalanchini@asst-pg23.it.

Differentiating COVID-19 pneumonia from acute respiratory distress syndrome and high altitude pulmonary edema: therapeutic implications

Impact of the coronavirus disease-19 outbreak on physical activity of patients with implantable cardioverters

A multisensor algorithm predicts heart failure events in patients with implanted devices: results from the MultiSENSE study

COVID-19, implantable cardioverterdefibrillator, remote monitoring, respiratory rate trend