Analysis of the Effectiveness of In‐Office and Transtelephonic Follow‐Up in Terms of Pacemaker System Complications

Abstract

A study was undertaken to determine the most effective method of pacemaker follow-up in terms of the total number of complications detected and yield per follow-up in single and dual chamber pacing systems. The analysis involved 9,786 patient records from 635 patients. The records were reviewed with respect to method of follow-up, number of chambers paced, and complications detected. Complications included: oversensing, undersensing, noncapture, pocket and diaphragmatic stimulation, pacemaker mediated tachycardia, crosstalk, pulse generator malfunction, lead malfunction, infection/erosion, premature end of service, exit block, and other miscellaneous problems. Eight thousand two hundred eighty-eight of the 9,786 follow-ups were performed in the office while 1,498 were transtelephonic. Single chamber pacing systems were implanted in 329 patients and 306 were dual chamber systems. A total of 599 complications were detected. Analysis yielded a per patient complication rate of 5.1% (single chamber) and 8.4% (dual chamber) for in-office follow-up. This compared to a transtelephonic follow-up per patient complication rate of only 0.3% (single chamber) and 1.0% (dual chamber). In-office pacemaker follow-up is significantly more effective (P < 0.001) than transtelephonic follow-up in detecting both single and dual chamber pacemaker system complications.

In‐home controls of pacemakers in debilitated elderly patients

“…In the USA, transtelephonic systems for pacemaker assessments have been used widely, sending baseline and magnet electrocardiogram (ECG) readings to a central operational base from the patient's home through a transtelephonic transmitter 2–4 . These systems, however, have never been implemented in Italy.…”

The Effectiveness of Transtelephonic Monitoring of Pacemaker Function in Pediatric Patients

“…Despite the benefits of reassurance, it is obviously important not to miss significant pacemaker dysfunction. Some studies have found that in‐office follow‐up of pacemaker patients detects more cases of pacemaker dysfunction than transtelephonic follow‐up 7,8 . In fact, the Canadian Working Group on Cardiac Pacing recommends direct patient follow‐up rather than transtelephonic monitoring but recognizes that the latter may be more practical in geographically isolated patients and in cases where frequent monitoring is required 9 .…”

Transtelephonic Versus Remote Monitoring of Cardiovascular Implantable Electronic Devices

“…Others have indicated that device problems could be identified throughout the life of a device and may be missed by TTM and that the existing Medicare guidelines may be inadequate for follow-up (13). What has become increasingly clear is that TTM may be useful for detecting battery depletion (14), but is significantly less effective in detecting all complications when compared with in-office pacemaker follow-up (15). This led to the recommendations by the Canadian Working Group on Cardiac Pacing that direct patient follow-up rather than TTM was desirable (16).…”