Telemedicine and cardiac implants: what is the benefit?

Niraj Varma, Renato Pietro Ricci, Niraj Varma, Renato Pietro Ricci

Abstract

Cardiac implantable electronic devices are increasing in prevalence. The post-implant follow-up is important for monitoring both device function and patient condition. However, practice is inconsistent. For example, ICD follow-up schedules vary from 3 monthly to yearly according to facility and physician preference and availability of resources. Recommended follow-up schedules impose significant burden. Importantly, no surveillance occurs between follow-up visits. In contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. Remote home monitoring reduces the volume of device clinic visits and provides early detection of patient and/or system problems.

Keywords: Atrial fibrillation; Cardiac implantable electronic devices; Early detection; Follow-up; ICD; Recall management; Remote monitoring.

Figures

Figure 1
Figure 1
Home Monitoring technology. Top: transmission steps in this fully automatic system (modified with permission from ref.). Both landline and portable GSM/landline patient modules are illustrated. Bottom Left >90% of transmissions were received in

Figure 2

The TRUST trial. Top left:…

Figure 2

The TRUST trial. Top left: continuous remote monitoring compared with standard of care.…

Figure 2
The TRUST trial. Top left: continuous remote monitoring compared with standard of care. Right: Home Monitoring reduced cardiac-resource utilization [scheduled and unscheduled clinic and hospital visits (including responses to Home Monitoring event notifications)] by 45% in 1 year. Bottom: time to physician evaluation of arrhythmias (left), and for silent events (right). Compiled with permission from ref.

Figure 3

Home Monitoring generator coupled to…

Figure 3

Home Monitoring generator coupled to a Fidelis (MDT 6949) lead. Two separate event…

Figure 3
Home Monitoring generator coupled to a Fidelis (MDT 6949) lead. Two separate event notifications that were transmitted immediately on occurrence of lead fracture, occurring silently during sleep at 4:43 am, 6 weeks after last clinic follow-up in November 14. Left: lead impedance suddenly increased; right: ventricular fibrillation detection due to irregular sensed events. Electrogram definition in current generation has improved resolution (1/128 s) and includes post-detection sequences (e.g. Figure 2). The patient was reviewed within hours (FU) of the notifications. Compiled with permission from ref.

Figure 4

Interrogation of a CRT-D device…

Figure 4

Interrogation of a CRT-D device in patient presenting with acute decompensated heart failure.…

Figure 4
Interrogation of a CRT-D device in patient presenting with acute decompensated heart failure. Compiled with permission from ref.

Figure 5

Home guide registry.

Figure 5

Home guide registry.

Figure 5
Home guide registry.
Figure 2
Figure 2
The TRUST trial. Top left: continuous remote monitoring compared with standard of care. Right: Home Monitoring reduced cardiac-resource utilization [scheduled and unscheduled clinic and hospital visits (including responses to Home Monitoring event notifications)] by 45% in 1 year. Bottom: time to physician evaluation of arrhythmias (left), and for silent events (right). Compiled with permission from ref.
Figure 3
Figure 3
Home Monitoring generator coupled to a Fidelis (MDT 6949) lead. Two separate event notifications that were transmitted immediately on occurrence of lead fracture, occurring silently during sleep at 4:43 am, 6 weeks after last clinic follow-up in November 14. Left: lead impedance suddenly increased; right: ventricular fibrillation detection due to irregular sensed events. Electrogram definition in current generation has improved resolution (1/128 s) and includes post-detection sequences (e.g. Figure 2). The patient was reviewed within hours (FU) of the notifications. Compiled with permission from ref.
Figure 4
Figure 4
Interrogation of a CRT-D device in patient presenting with acute decompensated heart failure. Compiled with permission from ref.
Figure 5
Figure 5
Home guide registry.

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Source: PubMed

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