Device Follow‐up in the Age of Automaticity

2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

“…Manufacturers' guidelines for device follow-up may vary with individual models and should be available. Device automaticity has facilitated follow-up, 316 as has the implementation of remote monitoring techniques. 513,517 Depending on the manufacturer, remote device interrogation is achieved through Internet-based systems or via radiofrequency transmissions from the ICD via a phone device to a central monitoring center; remote reprogramming of devices is not available currently.…”

“…Automatic features, such as automatic threshold assessment, have been incorporated increasingly into newer devices and facilitate follow-up for patients who live far from follow-up clinics. 316 However, these automatic functions are not universal and need not and cannot supplant the benefits of direct patient contact, particularly with regard to history taking and physical examination.…”

Transtelephonic Versus Remote Monitoring of Cardiovascular Implantable Electronic Devices

“…Automaticity in devices, such as automatic threshold assessment, may alert the physician to the need for intensified follow-up and device adjustments and may reduce the frequency or duration of office visits. It cannot, however, supplant direct patient/pacemaker evaluation (9).…”

Contemporary Pacemaker and Defibrillator Device Therapy

“…The technology has shown that there is a relatively long trouble-free period in the midst of a device's life; most issues arise early after implantation (wound healing, threshold changes) or toward the device's end of life. 30 These lessons have been applied increasingly to the management of ICDs; depending on the manufacturer, remote monitoring may be enabled through Internet-based systems or through radiofrequency transmission from a transmitter in the ICD via a phone device to a service center. Nonetheless, there is no substitute for direct patient contact, with an essential role for the physician to uncover device-related issues.…”

“…The latter may be defined as the automatic regulation of device function by programmed algorithms (see below) that are based on patient conditions and pacemaker/ICD system conditions, without the need for clinician input. 30 Transtelephonic monitoring of pacemakers has been available for nearly 3 decades. The technology has shown that there is a relatively long trouble-free period in the midst of a device's life; most issues arise early after implantation (wound healing, threshold changes) or toward the device's end of life.…”