Should physicians instead of industry representatives be the main actor of cardiac implantable electronic device follow-up? (Super Follow-up)

Abstract

Objective:This retrospective study sought to research the adequacy of the follow-up and optimization of cardiac implantable electronic devices (CIEDs) performed by industry representatives.Methods:A total of 403 consecutive patients (35% females; median age, 67 years; age range 18–97 years) with either pacemakers (n=246), implantable cardioverter-defibrillators (ICDs), (n=117) or cardiac resynchronization therapy with defibrillator (CRT-D) (n=40) applied to our hospital’s outpatient pacemaker clinic for follow-up. These patients had been followed up by industry representatives alone until September 2013 and then by a cardiologist who is dealing with cardiac electrophysiology and has a knowledge of CIED follow-up.Results:It was ascertained that 117 (47.6%) of 246 patients with pacemakers had a programming error. Forty-three (36.8%) of 117 patients were symptomatic, and after reprogramming, all symptoms diminished partially or completely during the follow-up. Moreover, 30 (25.6%) of 117 patients with ICDs had a programming error. Furthermore, 6 (15%) of 40 patients with CRT-Ds had a programming error. To conclude, when all patients with CIEDs were assessed together, it was ascertained that 153 (38%) of 403 patients had programming errors.Conclusion:The prevalence of inappropriate programming of CIEDs by industry representatives was quite higher than expected. Therefore, our study strongly demonstrates that CIED follow-up should not be allowed to be performed entirely by manufacturers’ representatives alone.

Who are the main actors of cardiac device follow-up? Analysis of the super follow-up study

“…We read with great interest the excellent paper titled “Should physicians instead of industry representatives be the main actor of cardiac implantable electronic device follow-up? (Super Follow-up)” by Üreyen et al ( 1 ) recently published in the Anatolian Journal of Cardiology 2017; 18: 23-30. The authors presented their work on the role of proper cardiac device follow-up performed by cardiologists.…”

“…Although the study conducted by Üreyen et al ( 1 ) is very beneficial to health professionals and individuals alike, some points warrant mention:…”

“… Üreyen et al ( 1 ) did not mention the role of AF detection algorithms (automatic mode switches) to assess whether such patients were in need of anticoagulation. According to the litera-ture, greater than 5–6 min spent in AF is an important predictor of stroke, with such patients in need of anticoagulation therapy based on CHADS2 or CHA2DS2VasC scores ( 2 ).…”

“…As cardiac electrophysiologists in North America, we are not allowed to change decay delay parameters in ICD patients without industry technical support. Üreyen et al ( 1 ) stated that cardiac implantable electronic devices (CIEDs) should be followed by medical doctors instead of industry representatives alone. We think that Üreyen et al ( 1 ) meant that the efforts of cardiac rhythm device clinic specialists, including cardiac electrophysiologists and specialized trained device technicians (nurses), should be in tandem to provide patient care.…”

“… Üreyen et al ( 1 ) stated that cardiac implantable electronic devices (CIEDs) should be followed by medical doctors instead of industry representatives alone. We think that Üreyen et al ( 1 ) meant that the efforts of cardiac rhythm device clinic specialists, including cardiac electrophysiologists and specialized trained device technicians (nurses), should be in tandem to provide patient care. One of the overlooked issues is to assess percentage of biventricular pacing in patients with CRT.…”