Design of the Pacemaker REmote Follow-up Evaluation and Review (PREFER) trial to assess the clinical value of the remote pacemaker interrogation in the management of pacemaker patients

Jane Chen, Bruce L Wilkoff, Wassim Choucair, Todd J Cohen, George H Crossley, W Ben Johnson, Luc R Mongeon, Gerald A Serwer, Lou Sherfesee, Jane Chen, Bruce L Wilkoff, Wassim Choucair, Todd J Cohen, George H Crossley, W Ben Johnson, Luc R Mongeon, Gerald A Serwer, Lou Sherfesee

Abstract

Background: Although pacemakers are primarily used for the treatment of bradycardia, diagnostic data available in current pacemakers allow them to be also used as sophisticated, continuous monitoring devices. Easy access to these stored data may assist clinicians in making diagnostic and therapeutic decisions sooner, thus avoiding potential long-term sequelae due to untreated clinical disorders. Internet-based remote device interrogation systems provide clinicians with frequent and complete access to stored data in pacemakers. In addition to monitoring device function, remote monitors may be a helpful tool in assisting physicians in the management of common arrhythmia disorders.

Methods: The Pacemaker REmote Follow-up Evaluation and Review (PREFER) trial is a prospective, randomized, parallel, unblinded, multicenter, open label clinical trial to determine the utility of remote pacemaker interrogation in the earlier diagnosis of clinically actionable events compared to the existing practice of transtelephonic monitoring. There have been 980 patients enrolled and randomized to receive pacemaker follow up with either remote interrogation using the Medtronic CareLink(R) Network (CareLink) versus the conventional method of transtelephonic monitoring (TTM) in addition to periodic in-person interrogation and programming evaluations. The purpose of this manuscript is to describe the design of the PREFER trial. The results, to be presented separately, will characterize the number of clinically actionable events as a result of pacemaker follow-up using remote interrogation instead of TTM.

Trial registration: ClinicalTrials.gov: NCT00294645.

Figures

Figure 1
Figure 1
Trial design flowchart. Trial design.

References

    1. Swerdlow CD, Schöls W, Dijkman B, Jung W, Sheth NV, Olson WH, Gunderson BD, for the Worldwide Jewel AF Investigators Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. Circulation. 2000;101:878–885.
    1. Glotzer TV, Hellkamp AS, Zimmerman J, Sweeney MO, Yee R, Marinchak R, Cook J, Paraschos A, Love J, Radoslovich G, Lee KL, Lamas GA. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST) Circulation. 2003;107:1614–1619. doi: 10.1161/01.CIR.0000057981.70380.45.
    1. Schoenfeld MH, Compton SJ, Mead RH, Weiss DN, Sherfesee L, Englund J, Mongeon LR. Remote Monitoring of Implantable Cardioverter Defibrillators: A Prospective Analysis. PACE. 2004;27:757–763.
    1. Ricci RP, Russo M, Santini M. Management of atrial fibrillation – What are the possibilities of early detection with home monitoring. Clin Res Cardiol. 2006;95:iii10–iii16. doi: 10.1007/s00392-006-1303-9.
    1. Ellery S, Pakrashi T, Paul V, Sack S, for the Home CARE Phase 0 Study Investigators Predicting mortality and rehospitalization in heart failure patients with Home Monitoring–The Home CARE pilot study. Clin Res Cardiol. 2006;95:iii29–iii35. doi: 10.1007/s00392-006-1306-6.
    1. Res CJ, Theuns DAMJ, Jordaens L. The role of remote monitoring in the reduction of inappropriate implantable cardioverter defibrillator therapies. Clin Res Cardiol. 2006;95:iii17–iii21. doi: 10.1007/s00392-006-1304-8.
    1. Centers for Medicare and Medicaid Services Coverage determinations: Transtelephonic monitoring of cardiac pacemakers. Medicare National Coverage Determinations Manual CMS Pub 100-3; Chapter 1, Part 1, Section 20811. October 3, 2003.
    1. Orlov MV, Ghali JK, Araghi-Niknam M, Sherfesee L, Sahr D, Hettrick D, for the Atrial High Rate Trial Investigators Asymptomatic Atrial Fibrillation in Pacemaker Recipients: Incidence, Progression, and Determinants Based on the Atrial High Rate Trial. PACE. 2007;30:404–411.
    1. Harrington DP, Fleming TR. A class of rank test procedures for censored survival data. Biometrika. 1982;69:553–566. doi: 10.1093/biomet/69.3.553.
    1. Gillis AM, Morck M. Atrial fibrillation after DDDR pacemaker implantation. J Cardiovasc Electrophysio. 2002;13:542–547. doi: 10.1046/j.1540-8167.2002.00542.x.
    1. Nergårdh A, Frick M. Perceived heart rhythm in relation to ECG findings after direct current cardioversion of atrial fibrillation. Heart. 2006;92:1244–1247. doi: 10.1136/hrt.2005.082156.
    1. Capucci A, Santini M, Padeletti L, Gulizia M, Botto GL, Boriani G, Ricci R, Favale S, Zolezzi F, Di Belardina N, Molon G, Drago F, Villani GQ, Mazzini E, Vimercati M, Grammatico A, Italian AT500 Registry Investigators Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers. J Am Coll Cardiol. 2005;46:1913–1920. doi: 10.1016/j.jacc.2005.07.044.
    1. Glotzer TV, Daoud EG, Wyse DG, Singer DE, Holbrook R, Pruett K, Smith K, Hilker CE. Rationale and design of a prospective study of the clinical significance of atrial arrhythmias detected by implanted device diagnostics: The TRENDS study. J Interv Card Electrophysiol. 2006;15:9–14. doi: 10.1007/s10840-006-7622-y.
    1. Hohnloser SH, Capucci A, Fain E, Gold MR, van Gelder IC, Healey J, Isreal CW, Lau CP, Morillo C, Connolly SJ, for the ASSERT Investigators and Committees Asymptomatic atrial fibrillation and stroke evaluation in pacemaker patients and atrial fibrillation reduction atrial pacing trial (ASSERT) AHA. 2006;152:442–447.
    1. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA, for the MOde Selection Trial (MOST) Investigators Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction. Circulation. 2003;107:2932–2937. doi: 10.1161/01.CIR.0000072769.17295.B1.

Source: PubMed

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