A Review on Remote Monitoring Technology Applied to Implantable Electronic Cardiovascular Devices

Abstract

Implantable electronic cardiovascular devices (IECD) include a broad spectrum of devices that have the ability to maintain rhythm, provide cardiac resynchronization therapy, and/or prevent sudden cardiac death. The incidence of bradyarrhythmias and other cardiac problems led to a broader use of IECD, which turned traditional follow-up into an extremely heavy burden for healthcare systems to support. Our aim was to assess the impact of remote monitoring on the follow-up of patients with IECD. We performed a review through PubMed using a specific query. The paper selection process included a three-step approach in which title, abstract, and cross-references were analyzed. Studies were then selected using previously defined inclusion criteria and analyzed according to the country of origin of the study, year, and journal of publication; type of study; and main issues covered. Twenty articles were included in this review. Eighty percent of the selected papers addressed clinical issues, from which 94% referred clinical events identification, clinical stability, time savings, or physician satisfaction as advantages, whereas 38% referred disadvantages that included both legal and technical issues. Forty-five percent of the papers referred patient issues, from which 89% presented advantages, focusing on patient acceptance/satisfaction, and patient time-savings. The main downsides were technical issues but patient privacy was also addressed. All the papers dealing with economic issues (20%) referred both advantages and disadvantages equally. Remote monitoring is presently a safe technology, widely accepted by patients and physicians, for its convenience, reassurance, and diagnostic potential. This review summarizes the principles of remote IECD monitoring presenting the current state-of-the-art. Patient safety and device interaction, applicability of current technology, and limitations of remote IECD monitoring are also addressed. The use of remote monitor should consider the selection of patients, the type of disease, and centers' availability to receive, interpret and respond to device alerts. Before remote IECD monitoring can be routinely used, technical, procedure, and ethical/legal issues should be addressed.

Non-pharmacological approaches applied in the control of cardiovascular diseases / Estratégias não medicamentosas utilizadas no controle de doenças cardiovasculares / Enfoques no farmacológicos aplicados en el control de las enfermedades cardiovasculares

“…Os dispositivos cardíacos eletrônicos implantáveis estão presentes na rotina clínica para controle de bradirritmias e outros problemas cardíacos no intuito de fornecer ressincronização cardíaca e prevenir mortes súbitas (16) . Um estudo revelou suas vantagens na detecção antecipada de eventos, em que a expectativa média de diagnóstico em pacientes que observaram eventos sintomáticos ou não, é de aproximadamente 58 dias (p <0,001), permitindo gerenciar e tratar dois meses antes da próxima consulta médica agendada (39) .…”

“…Destes 45% apresentavam questões diretas aos pacientes (aceitação/satisfação do paciente e economia de tempo), e 20% apresentam vantagens relacionadas às questões econômicas (diminuição de custos de acompanhamento) (16) .…”

Implantable Devices: Issues and Challenges

“…This increasing complexity of signal processing electronics further adds to the power budget of the device, which should remain very low if the device is to remain operational for extended periods of time. For instance, a ultra wide band technology offers high-speed data transfer between the implanted device, e.g., implantable electronic cardiovascular devices, and the medical practitioner, and low interference potential, yet its implementation is limited due to its high power consumption [36,37]. Although the wireless programming is highly application-specific, differing significantly between that for a pacemaker and a wireless pulse oxymeter, subjectivity of a particular wireless technology to interference is an important factor to consider, given that the wireless devices operate within an electromagnetically shared environment.…”

“…A closed loop system encompasses both the indwelling sensing and the stimulation components, and all information transfer and processing takes place within the body of the patient. This type of an implantable electronics is commonly employed to maintain a certain level of function within the human body, e.g., cardiac resynchronization, to enable automated provision of medical care and prevention of critical incidents, e.g., sudden cardiac death [37]. Hemodynamic sensors have been integrated into implantable pacemakers to enable rate-responsive pacing; these closed loop systems function on both sensed and paced ventricular beats, thus surmounting the key constraint of the previous pacemaker systems, namely the need for permanent ventricular pacing [49].…”

Monitorização à distância no seguimento de portadores de dispositivos cardíacos implantados

“…De acordo com uma revisão recente de publicações dedicadas à monitorização à distância em portadores de dispositivos cardíacos, 38% dos estudos incluíram as questões legais e os aspetos técnicos nas desvantagens associadas a esta modalidade de seguimento 31 .…”