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Introduction Remote monitoring (RM) is commonly used in the follow-up of patients with cardiac implantable devices (CID). However, there are a significant amount of automatic alerts of low clinical relevance. An alert classification model designed to optimize the management of RM alert in CID receivers can improve the analysis. Purpose Assess the effectiveness of a local protocol for review and classification of MR alerts. Methods Retrospective study, single center. We included all patients with ICD +/− CRT in the RM program between september 2016 and december 2019. All transmission received were analyzed. The priority of the transmissions was established based on clinical criteria and device parameters, classified into 3 categories from lowest to highest priority: green, yellow and red. Each category involved a specific action protocol (Figure 1). The categorization by colors was initially carried out by a remote support center, based on data from the devices; and later, reviewed by arrhythmia nurse team who incorporated clinical information data. In case of discrepancy, the alert was again evaluated together with the cardiologist. The degree of concordance in the categorization of alerts was analyzed, as well as the transmission response time (TRT): support center- care team. Results In our center a total of 1013 patients were included (68±14 years old, 76% male), who completed 8755 remote transmissions. The initial classification of transmissions by the support center was: 6890 (78.7%) green, 1497 (17.1%) yellow and 368 (4.2%) red. Only 0.62% of transmissions required reclassification by the healthcare team. No alert initially classified as yellow or green should be reclassified to red. The TRT was 3.35 hours for the red transmissions and 5.6 hours for the yellow ones. Conclusion The categorization of alerts in our RM system allows an efficient and safe organization of assitance to patients with CID. Funding Acknowledgement Type of funding source: None

Introduction Remote monitoring (RM) of cardiac devices is a technology established in clinical practice. The early activation of RM is associated with greater survival. The RM of leadless pacemakers consists of a non-automatic remote interrogation (RI), however factors such as age, the monitoring center and the type of device delivered can condition the adequate adherence to the system. Purpose Describe the results of RM in patients with leadless pacemakers in the clinical practice of a tertiary referral hospital. Methods All patients with leadless pacemakers were included. Since October 2017, RM was offered to all new patients and to previously implanted patients who had an elevated threshold. Clinical and demographic characteristics were analyzed. The following variables were evaluated: Activation (first RI), early activation (activation occurring before 90 days from the implant or from the medical order), premature activation (activation before 15 days), and adherence to follow-up (patients with almost one RI after 12 months from activation). Results A total of 142 patients have been implanted with a leadless pacemaker, of which 56 patients were offered RM, being accepted in 96% of the cases (54 patients, 88±6 years old, 54% males). A 54% patients received a RM using App based technology. During a mean follow-up of 200 days, 7 deaths occurred (13%). 100% of the patients have performed the activation, being in all cases an early activation, and in 50% (26 patients) it has been premature activation. 32 patients have follow-up longer than 12 months and all are adherent to RM. There are no differences in the percentage of activation or adherence depending on the type of monitor. Conclusions The implementation of RM program in old patients with a leadless pacemaker has a high acceptance rate, achieving an early activation in all patients. The adherence to this technology remains high despite the limitation of a non automatic transmission. RM using App based technology is possible in spite of the age.