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Kobe EA, McVeigh T, Hameed I, Fudim M. Heart Failure Remote Monitoring: A Review and Implementation How-To. J Clin Med 2023; 12:6200. [PMID: 37834845 PMCID: PMC10573601 DOI: 10.3390/jcm12196200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Heart failure (HF) is a significant clinical and financial burden worldwide. Remote monitoring (RM) devices capable of identifying early physiologic changes in decompensation have the potential to reduce the HF burden. However, few trials have discussed at length the practical aspects of implementing RM in real-world clinical practice. The present paper reviews current RM devices and clinical trials, focusing on patient populations, outcomes, data collection, storage, and management, and describes the implementation of an RM device in clinical practice, providing a pragmatic and adaptable framework.
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Affiliation(s)
- Elizabeth A. Kobe
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Todd McVeigh
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Ishaque Hameed
- Department of Medicine, DOW University of Health Sciences, Karachi 74200, Pakistan
| | - Marat Fudim
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
- Duke Clinical Research Institute, Durham, NC 27710, USA
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Götz TF, Proff J, Timmel T, Jilek C, Tiemann K, Lewalter T. Potential of remote monitoring to prevent sensing and detection failures in implantable cardioverter defibrillators. Herzschrittmacherther Elektrophysiol 2021; 33:63-70. [PMID: 34468842 DOI: 10.1007/s00399-021-00802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sensing malfunction and misinterpretation of intracardiac electrograms (IEGMs) in patients with implantable cardioverter defibrillators (ICDs) may lead to inadequate device activity such as inappropriate shock delivery or unnecessary mode-switching. Remote monitoring has the potential for early detection of sensing malfunction or misclassification and may thus prevent adverse device activity. Therefore, the authors analyzed the amount, nature, and distribution of misclassification in current ICD and cardiac resynchronization therapy defibrillator technology using the device transmissions of the IN-TIME study population. METHODS All transmitted tachyarrhythmic episodes in the 664 IN-TIME patients, comprising 2214 device-classified atrial fibrillation (DC-AF) episodes lasting ≥ 30 s and 1330 device-classified ventricular tachycardia or fibrillation (DC-VT/VF) episodes, were manually analyzed by two experienced cardiologists. RESULTS After evaluation of all DC-VT/VF episodes, a total of 300 VT/VF events (23.1%) were false-positive, with supraventricular tachycardia being the most frequent cause (51.7%), followed by atrial fibrillation (21.3%) and T‑wave oversensing (21.0%). A total of 15 patients with false-positive DC-VT/VF received inappropriate shocks. According to the inclusion criteria, 616 IEGMs with DC-AF were assessed. A total of 19.7% were false-positive AF episodes and R‑wave oversensing was the most common reason (55.9%). CONCLUSIONS Remote monitoring offers the opportunity of early detection of signal misclassification and thus early prevention of adverse device reaction, such as inappropriate shock delivery or mode-switching with intermittent loss of atrioventricular synchrony, by correcting the underlying causes.
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Affiliation(s)
- Tobias Franz Götz
- Klinik für Kardiologie und Internistische Intensivmedizin, Peter Osypka Herzzentrum, Internistisches Klinikum München Süd GmbH, Am Isarkanal 36, 81379, München, Germany. .,Klinik für Kardiologie, Universitätsklinikum Bonn, Bonn, Germany.
| | | | | | - Clemens Jilek
- Klinik für Kardiologie und Internistische Intensivmedizin, Peter Osypka Herzzentrum, Internistisches Klinikum München Süd GmbH, Am Isarkanal 36, 81379, München, Germany
| | - Klaus Tiemann
- Klinik für Kardiologie und Internistische Intensivmedizin, Peter Osypka Herzzentrum, Internistisches Klinikum München Süd GmbH, Am Isarkanal 36, 81379, München, Germany.,I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Thorsten Lewalter
- Klinik für Kardiologie und Internistische Intensivmedizin, Peter Osypka Herzzentrum, Internistisches Klinikum München Süd GmbH, Am Isarkanal 36, 81379, München, Germany.,Klinik für Kardiologie, Universitätsklinikum Bonn, Bonn, Germany
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Delnoy PPHM, Gutleben KJ, Bruun NE, Maier SKG, Oswald H, Stellbrink C, Johansen JB, Paule S, Søgaard P. Hemodynamic monitoring by intracardiac impedance measured by cardiac resynchronization defibrillators: Evaluation in a controlled clinical setting (BIO.Detect HF II study). Indian Pacing Electrophysiol J 2021; 21:209-218. [PMID: 33866018 PMCID: PMC8263311 DOI: 10.1016/j.ipej.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background In patients with cardiac resynchronization therapy defibrillators (CRT-Ds), intracardiac impedance measured by dedicated CRT-D software may be used to monitor hemodynamic changes. We investigated the relationship of hemodynamic parameters assessed by intracardiac impedance and by echocardiography in a controlled clinical setting. Methods The study enrolled 68 patients (mean age, 66 ± 9 years; 74% males) at 12 investigational sites. The patients had an indication for CRT-D implantation, New York Heart Association class II/III symptoms, left ventricular ejection fraction 15%–35%, and a QRS duration ≥150 ms. Two months after a CRT-D implantation, hemodynamic changes were provoked by overdrive pacing. Intracardiac impedance was recorded at rest and at four pacing rates ranging from 10 to 40 beats/min above the resting rate. In parallel, echocardiography measurements were performed. We hypothesized that a mean intra-individual correlation coefficient (rmean) between stroke impedance (difference between end-systolic and end-diastolic intracardiac impedance) measured by CRT-D and the aortic velocity time integral (i.e., stroke volume) determined by echocardiography would be significantly larger than 0.65. Results The hypothesis was evaluated in 40 patients with complete data sets. The rmean was 0.797, with a lower confidence interval bound of 0.709. The study hypothesis was met (p = 0.007). A stepwise reduction of stroke impedance and stroke volume was observed with increasing heart rate. Conclusions Intracardiac impedance measured by implanted CRT-Ds correlated well with the aortic velocity time integral (stroke volume) determined by echocardiography. The impedance measurements bear potential and are readily available technically, not requiring implantation of additional material beyond standard CRT-D system. Intracardiac impedance measurement feature (ICI-MF) is integrated in some CRT-Ds. We studied relationship between echo hemodynamic parameters and ICI-MF of CRT-Ds. Stroke volume by echo correlated well with stroke impedance by ICI-MF of CRT-Ds. Stepwise reduction in stroke impedance and stroke volume with increasing heart rate. The ICI-MF bears potential and requires only a ‘standard’ CRT-D system implantation.
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Affiliation(s)
| | | | - Niels Eske Bruun
- Clinical Institute, Copenhagen and Aalborg Universities, Dept. Cardiology, Zealand University Hospital, Roskilde, Denmark
| | | | - Hanno Oswald
- Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | | - Peter Søgaard
- Heart Center and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Hindricks G, Varma N, Kacet S, Lewalter T, Søgaard P, Guédon-Moreau L, Proff J, Gerds TA, Anker SD, Torp-Pedersen C. Daily remote monitoring of implantable cardioverter-defibrillators: insights from the pooled patient-level data from three randomized controlled trials (IN-TIME, ECOST, TRUST). Eur Heart J 2019; 38:1749-1755. [PMID: 29688304 PMCID: PMC5461472 DOI: 10.1093/eurheartj/ehx015] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/18/2017] [Indexed: 11/26/2022] Open
Abstract
Aims Remote monitoring of implantable cardioverter-defibrillators may improve clinical outcome. A recent meta-analysis of three randomized controlled trials (TRUST, ECOST, IN-TIME) using a specific remote monitoring system with daily transmissions [Biotronik Home Monitoring (HM)] demonstrated improved survival. We performed a patient-level analysis to verify this result with appropriate time-to-event statistics and to investigate further clinical endpoints. Methods and results Individual data of the TRUST, ECOST, and IN-TIME patients were pooled to calculate absolute risks of endpoints at 1-year follow-up for HM vs. conventional follow-up. All-cause mortality analysis involved all three trials (2405 patients). Other endpoints involved two trials, ECOST and IN-TIME (1078 patients), in which an independent blinded endpoint committee adjudicated the underlying causes of hospitalizations and deaths. The absolute risk of death at 1 year was reduced by 1.9% in the HM group (95% CI: 0.1–3.8%; P = 0.037), equivalent to a risk ratio of 0.62. Also the combined endpoint of all-cause mortality or hospitalization for worsening heart failure (WHF) was significantly reduced (by 5.6%; P = 0.007; risk ratio 0.64). The composite endpoint of all-cause mortality or cardiovascular (CV) hospitalization tended to be reduced by a similar degree (4.1%; P = 0.13; risk ratio 0.85) but without statistical significance. Conclusion In a pooled analysis of the three trials, HM reduced all-cause mortality and the composite endpoint of all-cause mortality or WHF hospitalization. The similar magnitudes of absolute risk reductions for WHF and CV endpoints suggest that the benefit of HM is driven by the prevention of heart failure exacerbation.
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Affiliation(s)
- Gerhard Hindricks
- Internal Medicine and Cardiology Division, University of Leipzig Heart Center, Strümpellstrasse 39, D-04289 Leipzig, Germany
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, 44195 Cleveland, OH, USA
| | - Salem Kacet
- Centre Hospitalier Régional et Universitaire, Lille, France
| | | | - Peter Søgaard
- Heart Centre and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Thomas A Gerds
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
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Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial. Clin Res Cardiol 2019; 108:1117-1127. [PMID: 30874886 PMCID: PMC6753058 DOI: 10.1007/s00392-019-01447-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/28/2019] [Indexed: 12/28/2022]
Abstract
Aims In the IN-TIME trial, automatic daily implant-based multiparameter telemonitoring significantly improved clinical outcomes in patients with chronic systolic heart failure and implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D). We compared IN-TIME results for ICD and CRT-D subgroups. Methods Patients with LVEF ≤ 35%, NYHA class II/III, optimized drug treatment, no permanent atrial fibrillation, and a dual-chamber ICD (n = 274) or CRT-D (n = 390) were randomized 1:1 to telemonitoring or no telemonitoring for 12 months. Primary outcome measure was a composite clinical score, classified as worsened if the patient died or had heart failure-related hospitalization, worse NYHA class, or a worse self-reported overall condition. Results The prevalence of worsened score at study end was higher in CRT-D than ICD patients (26.4% vs. 18.2%; P = 0.014), as was mortality (7.4% vs. 4.1%; P = 0.069). With telemonitoring, odds ratios (OR) for worsened score and hazard ratios (HR) for mortality were similar in the ICD [OR = 0.55 (P = 0.058), HR = 0.39 (P = 0.17)] and CRT-D [OR = 0.68 (P = 0.10), HR = 0.35 (P = 0.018)] subgroups (insignificant interaction, P = 0.58–0.91). Conclusion Daily multiparameter telemonitoring has a potential to reduce clinical endpoints in patients with chronic systolic heart failure both in ICD and CRT-D subgroups. The absolute benefit seems to be higher in higher-risk populations with worse prognosis. Electronic supplementary material The online version of this article (10.1007/s00392-019-01447-5) contains supplementary material, which is available to authorized users.
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Varma N, Piccini JP, Snell J, Fischer A, Dalal N, Mittal S. The Relationship Between Level of Adherence to Automatic Wireless Remote Monitoring and Survival in Pacemaker and Defibrillator Patients. J Am Coll Cardiol 2015; 65:2601-2610. [DOI: 10.1016/j.jacc.2015.04.033] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
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Abstract
Cardiac implantable electronic devices (CIEDs) store clinically valuable, time-sensitive information regarding system integrity, arrhythmias, and heart failure parameters. Remote monitoring has impacted clinical practice by reducing scheduled office visits, providing protocols for device recalls and advisories, and facilitating the management of unscheduled encounters. The successful implementation of remote monitoring into clinical practice requires a new work flow and additional staff; the use of the electronic medical record to manage the data emanating from CIEDs poses an additional challenge. Solutions to these issues are discussed, and projections are made regarding the management of CIEDs in a modern electrophysiology practice.
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Hindricks G, Taborsky M, Glikson M, Heinrich U, Schumacher B, Katz A, Brachmann J, Lewalter T, Goette A, Block M, Kautzner J, Sack S, Husser D, Piorkowski C, Søgaard P. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 2014; 384:583-590. [PMID: 25131977 DOI: 10.1016/s0140-6736(14)61176-4] [Citation(s) in RCA: 502] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND An increasing number of patients with heart failure receive implantable cardioverter-defibrillators (ICDs) or cardiac resynchronisation defibrillators (CRT-Ds) with telemonitoring function. Early detection of worsening heart failure, or upstream factors predisposing to worsening heart failure, by implant-based telemonitoring might enable pre-emptive intervention and improve outcomes, but the evidence is weak. We investigated this possibility in IN-TIME, a clinical trial. METHODS We did this randomised, controlled trial at 36 tertiary clinical centres and hospitals in Australia, Europe, and Israel. We enrolled patients with chronic heart failure, NYHA class II-III symptoms, ejection fraction of no more than 35%, optimal drug treatment, no permanent atrial fibrillation, and a recent dual-chamber ICD or CRT-D implantation. After a 1 month run-in phase, patients were randomly assigned (1:1) to either automatic, daily, implant-based, multiparameter telemonitoring in addition to standard care or standard care without telemonitoring. Investigators were not masked to treatment allocation. Patients were masked to allocation unless they were contacted because of telemonitoring findings. Follow-up was 1 year. The primary outcome measure was a composite clinical score combining all-cause death, overnight hospital admission for heart failure, change in NYHA class, and change in patient global self-assessment, for the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT00538356. FINDINGS We enrolled 716 patients, of whom 664 were randomly assigned (333 to telemonitoring, 331 to control). Mean age was 65·5 years and mean ejection fraction was 26%. 285 (43%) of patients had NYHA functional class II and 378 (57%) had NYHA class III. Most patients received CRT-Ds (390; 58·7%). At 1 year, 63 (18·9%) of 333 patients in the telemonitoring group versus 90 (27·2%) of 331 in the control group (p=0·013) had worsened composite score (odds ratio 0·63, 95% CI 0·43-0·90). Ten versus 27 patients died during follow-up. INTERPRETATION Automatic, daily, implant-based, multiparameter telemonitoring can significantly improve clinical outcomes for patients with heart failure. Such telemonitoring is feasible and should be used in clinical practice. FUNDING Biotronik SE & Co. KG.
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Affiliation(s)
| | - Milos Taborsky
- Department of Internal Medicine I-Cardiology, Faculty of Medicine and Dentistry, Olomouc, Czech Republic
| | | | | | | | - Amos Katz
- Barzilai Medical Center, Ashkelon, Israel
| | | | | | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | - Peter Søgaard
- Heart Centre and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Cardiac remote monitoring in France. Arch Cardiovasc Dis 2014; 107:253-60. [DOI: 10.1016/j.acvd.2014.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 01/09/2023]
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Periprocedural Management of Cardiac Resynchronization Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:298. [DOI: 10.1007/s11936-014-0298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Varma N, Ricci RP. Telemedicine and cardiac implants: what is the benefit? Eur Heart J 2013; 34:1885-95. [PMID: 23211231 PMCID: PMC4051258 DOI: 10.1093/eurheartj/ehs388] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 10/15/2012] [Accepted: 10/23/2012] [Indexed: 11/12/2022] Open
Abstract
Cardiac implantable electronic devices are increasing in prevalence. The post-implant follow-up is important for monitoring both device function and patient condition. However, practice is inconsistent. For example, ICD follow-up schedules vary from 3 monthly to yearly according to facility and physician preference and availability of resources. Recommended follow-up schedules impose significant burden. Importantly, no surveillance occurs between follow-up visits. In contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. Remote home monitoring reduces the volume of device clinic visits and provides early detection of patient and/or system problems.
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Affiliation(s)
- Niraj Varma
- Cardiac Pacing and Electrophysiology, 9500 Euclid Avenue Desk J2-2, Cleveland Clinic, Cleveland, OH 44195, USA.
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Santini M. Remote monitoring and the twin epidemics of atrial fibrillation and chronic heart failure. Europace 2013; 15 Suppl 1:i47-i48. [PMID: 23737230 DOI: 10.1093/europace/eut120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Massimo Santini
- Cardiovascular Department, S Filippo Neri Hospital, Via Martinotti 20, Rome, Italy.
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Varma N, Brugada P. Automatic remote monitoring: milestones reached, paths to pave. Europace 2013; 15 Suppl 1:i69-i71. [DOI: 10.1093/europace/eut118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Müller A, Goette A, Perings C, Nägele H, Konorza T, Spitzer W, Schulz SS, von Bary C, Hoffmann M, Albani M, Sack S, Niederlöhner A, Lewalter T. Potential Role of Telemedical Service Centers in Managing Remote Monitoring Data Transmitted Daily by Cardiac Implantable Electronic Devices: Results of the Early Detection of Cardiovascular Events in Device Patients with Heart Failure (detecT-Pilot) Study. Telemed J E Health 2013; 19:460-6. [DOI: 10.1089/tmj.2012.0154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Axel Müller
- Clinic of Internal Medicine I, Chemnitz Hospital, Chemnitz, Germany
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Paderborn, Germany
| | | | | | - Thomas Konorza
- University Hospital Essen, Westdeutsches Herzzentrum, Essen, Germany
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Dubner S, Auricchio A, Steinberg JS, Vardas P, Stone P, Brugada J, Piotrowicz R, Hayes DL, Kirchhof P, Breithardt G, Zareba W, Schuger C, Aktas MK, Chudzik M, Mittal S, Varma N, Israel (Germany) C, Padeletti (Italy) L, Brignole (Italy) M. ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs). Europace 2012; 14:278-93. [DOI: 10.1093/europace/eur303] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dubner S, Auricchio A, Steinberg JS, Vardas P, Stone P, Brugada J, Piotrowicz R, Hayes DL, Kirchhof P, Breithardt G, Zareba W, Schuger C, Aktas MK, Chudzik M, Mittal S, Varma N. ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs). Ann Noninvasive Electrocardiol 2012; 17:36-56. [PMID: 22276627 PMCID: PMC6932107 DOI: 10.1111/j.1542-474x.2011.00484.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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 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, implantable cardioverter defibrillators, devices for cardiac resynchronization therapy (both with and without defibrillation properties), loop recorders, and hemodynamic 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 and the European Heart Rhythm Association combined their expertise in this field. We hope that the development of this field can contribute to improve care of our cardiovascular patients.
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Affiliation(s)
- Sergio Dubner
- Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina.
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