ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs)

Abstract

We are in the midst of a rapidly evolving era of technology-assisted medicine. The field of telemedicine provides the opportunity for highly individualized medical management in a way that has never been possible before. Evolving medical technologies using cardiac implantable devices (CIEDs) with capabilities for remote monitoring permit evaluation of multiple parameters of cardiovascular physiology and risk, including cardiac rhythm, device function, blood pressure values, the presence of myocardial ischaemia, and the degree of compensation of congestive heart failure. Cardiac risk, device status, and response to therapies can now be assessed with these electronic systems of detection and reporting. This document reflects the extensive experience from investigators and innovators around the world who are shaping the evolution of this rapidly expanding field, focusing in particular on implantable pacemakers (IPGs), implantable cardioverter-defibrillators (ICDs), devices for cardiac resynchronization therapy (CRT) (both, with and without defibrillation properties), loop recorders, and haemodynamic monitoring devices. This document covers the basic methodologies, guidelines for their use, experience with existing applications, and the legal and reimbursement aspects associated with their use. To adequately cover this important emerging topic, the International Society for Holter and Noninvasive Electrocardiology (ISHNE) and the European Heart Rhythm Association (EHRA) combined their expertise in this field. We hope that the development of this field can contribute to improve care of our cardiovascular patients.

HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices

“…4,5 Practically all information obtained during an in-office device checkup can now be obtained remotely. An important exception to this is the data for measuring the pacing capture threshold, which is available only for devices capable of automatically measuring the capture threshold.…”

“…4 The goals for follow-up, hardware definitions, and personnel remain the same and will not be covered in this document, except for cases in which remote technologies and responsibilities have evolved. The present document provides new recommendations based on data published since 2008, endorses the need to maintain consistent follow-up, and outlines the limitations of strictly inperson methods.…”

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

“…The standard guidelines published by the Heart Rhythm Society and European Heart Rhythm Association recommend that the maximum interval between transmissions of cardiovascular implantable electronic device RM should be 3 to 12 months. 79 RM harnesses the power of telemedicine for early identification of arrhythmias and device malfunctions, prompting earlier corrective measures for pediatric patients. RM has been reported to improve the care and safety of patients in multiple studies.…”

Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics

“…Evolving medical technologies using cardiac implantable devices with capabilities for remote monitoring permit evaluation of multiple parameters of cardiovascular physiology and risk, including cardiac rhythm, device function, blood pressure values, the presence of myocardial ischemia, and the degree of compensation of congestive HF [53,54]. Cardiac risk, device status, and response to therapies can now be assessed with these electronic systems of detection and reporting.…”