Day by day telemetric care of patients treated with cardiac resynchronisation therapy: first Polish experience

Abstract

A b s t r a c tBackground: Due to the recent rapid increase in the number of patients implanted with pacemakers, cardioverter-defibrillators (ICD), and cardiac resynchronisation therapy devices (CRT), conventional monitoring at specialist clinics is becoming increasingly difficult. The development of technology has enabled remote device monitoring with the use of teletransmission systems. Aim:To assess the effectiveness of transmission and the possibility of using telemetric data for further clinical management of patients with heart failure (HF) treated with CRT-D. Methods:The analysis included 305 consecutive patients with chronic HF, New York Heart Association functional classes II-IV, treated with the use of CRT-D by Biotronik or Medtronic in the years 2006-2012. The patients received transmitters, enabling the remote monitoring of the implanted device from the patients' houses. Scheduled reports were automatically sent every month. The triggers for pre-specified emergency alert transmissions were as follows: ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes, CRT-D intervention, ventricular extrasystoles > 110/h, any episode of atrial fibrillation (AF), atrial flutter (AFL) or supraventricular tachycardia, mean heart rate (HR) during, mean 24-h HR, CRT pacing < 95%, Elective Replacement Indicator, or End Of Service and device malfunction. The all-cause mortality of the study population has been assessed at the end of the follow-up period (mean of 20.5 months). Results:Devices manufactured by Biotronik were provided to 71% of the study population, while 29% received devices by Medtronic. In 97.3% of cases, the monitors were wireless, fully automatic, and capable of immediate data transmission whenever a pre-specified alert notification was fulfilled. The analysis of long-term outcomes revealed that all-cause mortality of the whole study population was 13%. The effectiveness of report transmission was 98%. During follow-up a total of 31,198 transmissions were received and analysed, which constituted, on average, 4.9 transmissions per patient per month. Among analyses, 30% were reports generated by scheduled remote follow-ups, and 70% were caused by unscheduled device alerts. Correct functioning of the system was confirmed; the quality of the received data was 100%. In 63.9% of patients, decisions based on the information obtained from telemonitoring reports were made to modify the therapy, refer the patients to cardiology or electrophysiology clinics, or hospitalise them urgently. The most common medical reaction was device reprogramming (46.8%). Pharmacotherapy was modified in 33.7% of patients: beta-blocker dose increase (25.9%), anticoagulant treatment inclusion (15.7%), amiodarone inclusion (1.9%), or digoxin inclusion (4.5%). The remaining medical responses were referring patients for atrioventricular junction ablation (8.1%), VT ablation (2.9%), or AF/AFl ablation (1.6%). Conclusions:Remote monitoring of implantable devices is feasible, safe, and effective in supervising patients wit...

Telemedical Monitoring Based on Implantable Devices—the Evolution Beyond the CardioMEMS™ Technology

“…Thus, telemonitoring allows assessing the relevant technical parameters of the device (battery status, electrode function, and system compatibility) and provides other key clinical information (stimulation percentage, arrhythmic episodes, or current intracardiac electrogram) [23,26]. In addition, novel telemetric strategies may provide data on the current clinical status or device alarms, including device-related malfunctions, arrhythmias, heart and respiratory rate statistics, heart sounds, and intrathoracic impedance [28][29][30][31].…”

<p>Cardiac Electronic Devices: Future Directions and Challenges</p>

“…8,62 The daily telemetric care of a large population of such CIED patients may be considered triage of high-risk patients, with ongoing selection of individuals who require urgent medical intervention. 64 According to expert consensus, remote monitoring should be available for all patients with CIEDs as part of the standard follow-up strategy, but in particular for patients with HF and cardiac arrhythmias. 8,62 There is urgent need for integrated medical care for patients with HF.…”

“…Importantly, the effectiveness of the therapy may be assessed on an ongoing basis. 64 A survey from the Health Economics Committee of the EHRA 25 showed that early recognition of AF among PM patients, lead failure in ICD patients, and HF worsening in CRT patients were considered essential advantages of remote monitoring. The opportunity comes from dual-chamber devices that can also monitor atrial rhythm, allowing the possibility of recognizing arrhythmias and AF.…”

“…8 , 62 The daily telemetric care of a large population of such CIED patients may be considered triage of high-risk patients, with ongoing selection of individuals who require urgent medical intervention. 64 …”

Challenges in the remote monitoring of cardiac implantable electronic devices in 2021

“…Data are transferred from patient's device into large databases, to which clinicians have internet-based access. The vast majority of relevant technical parameters can be assessed by telemonitoring including recorded arrhythmias, battery longevity, electrodes properties, stimulation percentage, and intra-cardiac electrograms [1,2] When conducted on a daily basis, remote monitoring (RM) of CIEDs is a valuable tool to screen and triage patients at very high risk of deterioration, to which offer personalized medical interventions [3]. Even though remote monitoring of any kind of CIEDs, including permanent pacemakers (PPM), implantable cardioverter defibrillators (ICD) and implantable cardiac monitors (ICM), could offer some advantages to patients and physicians [4], it is especially true for subgroups of patients.…”