1
|
Zhang H, Gao H, Liu X, Mu X, Shi X. A novel non-contact remote interrogate system based on 5G telecommunication technique during cardiac implantable electrical devices implantation against the background of the global COVID-19 pandemic. Chin Med J (Engl) 2023; 136:623-625. [PMID: 36804461 PMCID: PMC10106252 DOI: 10.1097/cm9.0000000000002069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Hong Zhang
- Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hai Gao
- Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xin Liu
- Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xijuan Mu
- Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | | |
Collapse
|
2
|
Smith B, Ashton L. Extreme pacemaker reel syndrome in an elderly patient with cognitive impairment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:353-357. [PMID: 32207647 DOI: 10.12968/bjon.2020.29.6.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Twiddler's syndrome is a rare cause of pacemaker failure, where patient manipulation of the pulse generator results in lead dislodgement or retraction. Variations in manifestation have been identified including reel syndrome, where rotation occurs around the transverse axis resulting in coiling of the leads, and ratchet syndrome where arm movement results in lead displacement. Device manipulation leading to device failure has been documented in up to 1.7% of implants, particularly in patients with large pockets or mental disorders. Such complications have serious consequences, particularly in pacing-dependent patients where loss of capture may result in asystole. This article reviews the case of an 84-year-old patient presenting at 8-month pacemaker follow-up in complete heart block with no evidence of pacemaker function.
Collapse
Affiliation(s)
- Bethany Smith
- Cardiac Physiologist, North Cumbria University Hospital
| | - Lisa Ashton
- Lecturer BSc Healthcare Science (Cardiac Physiology), School of Medicine, University of Leeds
| |
Collapse
|
3
|
Morales JL, Nava S, Márquez MF, González J, Gómez-Flores J, Colín L, Martínez-Ríos MA, Iturralde P. Idiopathic Lead Migration: Concept and Variants of an Uncommon Cause of Cardiac Implantable Electronic Device Dysfunction. JACC Clin Electrophysiol 2017; 3:1321-1329. [PMID: 29759631 DOI: 10.1016/j.jacep.2017.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/15/2017] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This cumulative case study was performed to properly address the possible mechanisms, forms, and consequences of "twiddler's," "reel," and "ratchet" syndromes. BACKGROUND Twiddler's, reel, and ratchet syndromes are rare entities responsible for lead displacement of cardiac implantable electronic devices (CIED). METHODS From 2007 to 2012, 1,472 CIED were implanted at our center. Eighty-nine cases were reviewed for failure of pacing circuit integrity. Only 9 met the inclusion criteria for idiopathic lead migration (ILM) and were grouped as ILM (twiddler) or ILM (reel). For a pooled analysis of cases, a review of the literature from 1990 to 2012 was performed, and the authors identified 78 cases from 64 publications. RESULTS The study population consisted of 87 cases (45 women; median age, 66 years; 46 with ILM [twiddler] and 41 with ILM [reel]). Migration affected only 1 lead in 65% of 46 devices with more than 1 lead. None of the previously reported risk factors-manual manipulation of the device, elderly age, obesity, oversized pocket, and psychiatric history-correlated with the risk of ILM. CONCLUSIONS Neither manual manipulation of the device nor the other traditional risk factors reported in the literature for ILM syndrome correlated with the risk of ILM.
Collapse
Affiliation(s)
- José L Morales
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Santiago Nava
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico.
| | - Manlio F Márquez
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Jorge González
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Jorge Gómez-Flores
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Luis Colín
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Marco A Martínez-Ríos
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Pedro Iturralde
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| |
Collapse
|
4
|
Konishi H, Tokano T, Nakazato Y, Komatsu S, Suwa S, Komatsu K, Hayashi H, Sekita G, Sumiyoshi M, Bito F, Kizu K, Daida H. Twiddler's syndrome detected by patient's complaint of implantable cardioverter-defibrillator rotation in the subcutaneous pocket. J Arrhythm 2012. [DOI: 10.1016/j.joa.2011.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
5
|
Laleci G, Dogac A, Yuksel M, Kabak Y, Arbelo E, Danmayr F, Hinterbuchner L, Chronaki C, Eichelberg M, Lüpkes C. Personalized Remote Monitoring of the Atrial Fibrillation Patients with Electronic Implant Devices. JOURNAL OF HEALTHCARE ENGINEERING 2011. [DOI: 10.1260/2040-2295.2.2.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
6
|
Reinsch N, Woydowski D, Schön H, Buddensiek M, Weissenberger W, Erbel R, Konorza T. [Home monitoring of an incessant VT in an ICD patient]. Herz 2010; 36:28-32. [PMID: 21181096 DOI: 10.1007/s00059-010-3411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 11/11/2010] [Indexed: 11/28/2022]
Abstract
Due to the increasing number of patients and complexity of modern tachycardia devices, efficient therapy monitoring as offered by telemedicine monitoring is of increasing importance. The potential advantages of remote control for patient management include early detection of device-related technical problems and arrhythmias. We report the case of an ICD patient with incessant ventricular tachycardia in whom immediate arrhythmia transmission was monitored by remote control.
Collapse
Affiliation(s)
- N Reinsch
- Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Hufelandstr. 55, 45122 Essen.
| | | | | | | | | | | | | |
Collapse
|
7
|
Migliore F, Leoni L, Torregrossa G, Guglielmi C, Tarantini G, Buja G, Iliceto S, Corrado D. Asymptomatic right ventricular perforation by an implantable cardioverter defibrillator lead detected by home monitoring system. J Electrocardiol 2010; 43:673-5. [DOI: 10.1016/j.jelectrocard.2010.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Indexed: 10/19/2022]
|
8
|
De Ruvo E, Gargaro A, Sciarra L, De Luca L, Zuccaro LM, Stirpe F, Rebecchi M, Sette A, Lioy E, Calò L. Early detection of adverse events with daily remote monitoring versus quarterly standard follow-up program in patients with CRT-D. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:208-16. [PMID: 21029128 DOI: 10.1111/j.1540-8159.2010.02932.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND A relative high rate of clinical and device-related adverse events (AE) is generally reported in patients with implantable defibrillators for cardiac resynchronization therapy (CRT-D). Aim of this study was to compare a daily remote monitoring (RM) to a standard program of in-office visits. METHODS AND RESULTS We retrospectively analyzed RM database and hospital files of 99 CRT-D consecutive patients who were visited in the out-patient clinic every 3-4 months; thirty-three patients were in addition controlled remotely with RM (RM group). Kaplan-Meier curves of clinical or device-related AE-free rates were obtained. During a median follow-up of 7 months, clinical AEs were: ventricular and atrial arrhythmias in 14 and 11 patients, low CRT pacing in nine, heart failure, strokes, or death in 15. Device-related AEs were: insufficient pacing/sensing performances in nine patients, lead dislodgement in five. As comparing the RM group with the remaining patients, Kaplan-Meier curves of clinical AEs diverged to significantly different rates: 23.8% (confidence interval [CI] 0.1%-47.5%) in the RM group and 48.7% (21.6-75.7%) in the remaining patients (P = 0.00002), with a hazard ratio of 0.14 (CI 0.06-0.37). Nondivergent Kaplan-Meier curves were obtained for device-related AE-free rates. CONCLUSION CRT-D patients followed with quarterly in-office visits without a daily RM system had an 86% higher risk of delayed detection of clinical AEs, during a median follow-up of 7 months.
Collapse
|
9
|
Bikou O, Licka M, Kathoefer S, Katus HA, Bauer A. Cost savings and safety of ICD remote control by telephone: a prospective, observational study. J Telemed Telecare 2010; 16:403-8. [PMID: 20870684 DOI: 10.1258/jtt.2010.090810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the costs and safety of follow-up of patients with an implantable cardioverter defibrillator (ICD). In a prospective study, a remote monitoring system was used to interrogate ICD devices via telephone. Twenty patients with an ICD were followed up conventionally (clinic visits) or remotely at 1, 3 and 6 months after implantation of the ICD. A total of 30 transmissions of ICD data were made via the remote monitoring system. Five transmissions (17%) were interrupted, mainly due to a loss of telemetry, but no data were lost. The duration of the remote follow-up was 12.7 min less than follow-up in clinic (25.8 min, P < 0.05). Five of the remote follow-up transmissions concerned arrhythmia episodes. These lasted significantly longer than those without arrhythmia (16.6 vs. 4.9 min, P < 0.05). In three patients an unscheduled visit to the outpatient clinic was necessary. The cost of remote follow-up for 100 ICD patients/year was calculated to be €44,267, or about 16% of the cost of conventional in-clinic follow-up.
Collapse
Affiliation(s)
- Olympia Bikou
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
| | | | | | | | | |
Collapse
|
10
|
Abstract
In several studies, ICD therapy has been shown to be an effective treatment option for patients suffering from or being at risk of malignant ventricular arrhythmias. Given the increasing rate of ICD implantations with the need for in-office interrogations at least twice a year, the number of follow-up visits is constantly growing. Remote transmission of relevant ICD data is a way to reduce follow-up burden for the physician, travel costs for the patient, and the time delay between onset of medical or device problems and an adequate physician response. In several studies, it has been demonstrated that remote ICD follow-up is safe and reduces follow-up resources for both the patient and the physician. With ongoing studies, the questions of whether remote ICD interrogations can offer additional diagnostic and therapeutic options that go beyond pure device follow-up and allow for a more complex management of ICD patients, who in fact represent a large percentage of the heart failure population, will have to be answered.
Collapse
Affiliation(s)
- P Sommer
- Abt. für Rhythmologie, Universität Leipzig - Herzzentrum, Strümpellstr. 39, 04289, Leipzig, Deutschland.
| | | | | |
Collapse
|
11
|
Andrikopoulos G, Tzeis S, Theodorakis G, Vardas P. Monitoring capabilities of cardiac rhythm management devices. Europace 2010; 12:17-23. [PMID: 19875398 DOI: 10.1093/europace/eup317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Since the advent of the first generation pacemakers, solely providing rate support, we have witnessed a technological outburst in the type and complexity of implantable devices. The introduction of implantable cardioverter defibrillators and later of cardiac resynchronization therapy devices enriched our therapeutic arsenal for the management of patients with heart failure and/or high risk of sudden cardiac death. In addition, during the last decade, newer generation cardiac rhythm management devices (CRMs) have been capable to provide a continuously expanding pool of diagnostic information derived by novel monitoring capabilities. Although at present the clinical role of this information is undervalued, it is evident that the clinical exploitation of data derived by CRMs may transform the standards of care for our patients by providing timely applied individualized diagnosis and treatment. In this context, even in the absence of solid data supporting the use of this information in everyday clinical practice, improving our familiarity with currently available monitoring algorithms is a prerequisite for the electrophysiologist who keeps in pace with the rapidly evolving technologies of CRMs and is prepared for their future role on clinical practice.
Collapse
|
12
|
Bernard ML, Quin EM, Gold MR. Remote Monitoring-The Future of Implantable Cardioverter-Defibrillator Follow-up. Card Electrophysiol Clin 2009; 1:193-200. [PMID: 28770784 DOI: 10.1016/j.ccep.2009.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Remote monitoring has developed out of the need to accommodate the demand of the growing implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) population. After several years of clinical use, remote device interrogation systems have demonstrated ease of use for both patient and provider, reliability compared with in-office interrogations, and the ability to detect asymptomatic but clinically significant events. The effect of remote monitoring on morbidity and mortality is currently unknown, but several trials are underway to assess these outcomes. Many devices also have the capacity to remotely track physiologic parameters that may improve the management of heart failure. Remote monitoring of ICD-CRT populations is a promising technological advancement that likely will become the standard of care for ICD follow-up.
Collapse
Affiliation(s)
- Michael L Bernard
- Medical University of South Carolina, 25 Courtenay Drive, ART 7031, MSC 592, Charleston, SC 29425-5920, USA
| | | | | |
Collapse
|
13
|
ORLOV MICHAELV, SZOMBATHY TAMAS, CHAUDHRY GMUQTADA, HAFFAJEE CHARLESI. Remote Surveillance of Implantable Cardiac Devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:928-39. [DOI: 10.1111/j.1540-8159.2009.02412.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Müller A, Helms TM, Neuzner J, Schweizer J, Korb H. Schrittmacher und interne Defibrillatoren mit kardiotelemedizinischer Unterstützung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:306-15. [DOI: 10.1007/s00103-009-0793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Sacher F, Probst V, Bessouet M, Wright M, Maluski A, Abbey S, Bordachar P, Deplagne A, Ploux S, Lande G, Jaïs P, Hocini M, Haïssaguerre M, Le Marec H, Clémenty J. Remote implantable cardioverter defibrillator monitoring in a Brugada syndrome population. Europace 2009; 11:489-94. [PMID: 19218576 DOI: 10.1093/europace/eup034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The diagnosis of Brugada syndrome (BS) is typically made in a young and otherwise healthy population. In patients with a high risk of sudden cardiac death (SCD), the only currently recommended therapy is an implantable cardioverter defibrillator (ICD), but these are not without complications. We investigated whether remote ICD monitoring could simplify follow-up and detect potential complications in these patients. METHODS AND RESULTS Thirty-five consecutive patients (26 males, 44 +/- 11 years) implanted with an ICD for BS with a remote monitoring ['Home Monitoring' (HM), Biotronik, Germany] system were prospectively enrolled in this study. They were matched for age, sex, and follow-up duration with 35 BS patients implanted with an ICD without this capability. During a mean follow-up of 33 +/- 17 months, the number of cardiology consultations was significantly lower in the HM group (3 +/- 2 vs. 7 +/- 3; P < 0.001). Inappropriate shock(s) [IS(s)] occurred in three patients (8.5%) in the HM group vs. six (17%) in the control group (P = NS). Ten patients in the HM group had a median of four alerts ('ventricular tachycardia/ventricular fibrillation detection' in all patients, 'shock' in three, 'ineffective shock' in two patients with shock on noise, 'extreme ventricular pacing impedance' in one patient due to lead failure, and 'deactivated therapy' in two patients with lead failure before replacement). In 5 of these 10 patients, prompt reprogramming of the ICD may have prevented IS(s). CONCLUSION Remote ICD monitoring in patients with BS decreases outpatient consultations and may help prevent ISs.
Collapse
|
16
|
Spencker S, Coban N, Koch L, Schirdewan A, Müller D. Potential role of home monitoring to reduce inappropriate shocks in implantable cardioverter-defibrillator patients due to lead failure. Europace 2008; 11:483-8. [PMID: 19103654 DOI: 10.1093/europace/eun350] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Lead dysfunctions in implantable cardioverter-defibrillator (ICD) patients can lead to inappropriate shocks or even complete loss of function of the device. Home monitoring (HM) systems are capable of daily data transmissions regarding the device and the lead integrity as well as information concerning anti-arrhythmic therapies. We therefore analysed the data from the Biotronik HM system whether it enables physicians to react quickly on serious ICD malfunctions and to avoid inappropriate shocks. METHODS AND RESULTS Fifty-four patients who had to undergo resurgery due to malfunctions of the ICD lead were included. Eleven of them were on HM interrogating the device every night at 3 am. If any adverse event was detected, a fax alert was sent to the clinic and the patients were asked for in-hospital ICD interrogation. The rate of inappropriate shocks and symptomatic pacemaker inhibition due to oversensing was compared with the 43 patients without remote surveillance. HM sent alert messages in 91% of all incidents. All lead failures became obvious because of oversensing of high frequency artefacts. Only in 18%, changes in the pacing impedance were noticed, in all cases preceded by oversensing. Eighty per cent of the patients were asymptomatic at the first onset of oversensing. Only one patient suffered an inappropriate shock as first manifestation of lead failure. Compared with the patients without HM, inappropriate shocks occurred in 27.3% in the HM group vs. 46.5% (P = n.s.). This trend gains statistical significance, if the compound endpoint of symptomatic lead failure consisting of inappropriate shocks and symptomatic pacemaker inhibition due to oversensing is focused: 27.3% event in the HM group vs. 53.4% in the group without HM (P = 0.04). Event messages were despatched in a mean of 54 days after the last ICD interrogation and 56 days before next scheduled visit. Thus, 56 days of reaction time are gained to avoid adverse events. CONCLUSION In 91% of all lead-related ICD complications, the diagnosis could be established correctly by an alert of the HM system. Mostly, the first incident sent was oversensing of artefacts, falsely detected as ventricular fibrillation-the VF zone. The automatic HM surveillance system enables physicians to detect severe lead problems early and to react quickly; thus, it might have a potential to avoid inappropriate shocks due to lead failure and T-wave oversensing.
Collapse
Affiliation(s)
- Sebastian Spencker
- Division of Cardiology, Charité-Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
| | | | | | | | | |
Collapse
|
17
|
Santini M, Ricci RP, Lunati M, Landolina M, Perego GB, Marzegalli M, Schirru M, Belvito C, Brambilla R, Guenzati G, Gilardi S, Valsecchi S. Remote monitoring of patients with biventricular defibrillators through the CareLink system improves clinical management of arrhythmias and heart failure episodes. J Interv Card Electrophysiol 2008; 24:53-61. [PMID: 18975066 DOI: 10.1007/s10840-008-9321-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
|
18
|
Jung W, Rillig A, Birkemeyer R, Miljak T, Meyerfeldt U. Advances in remote monitoring of implantable pacemakers, cardioverter defibrillators and cardiac resynchronization therapy systems. J Interv Card Electrophysiol 2008; 23:73-85. [DOI: 10.1007/s10840-008-9311-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 08/11/2008] [Indexed: 11/24/2022]
|
19
|
Hauck M, Bauer A, Voss F, Weretka S, Katus HA, Becker R. "Home monitoring" for early detection of implantable cardioverter-defibrillator failure: a single-center prospective observational study. Clin Res Cardiol 2008; 98:19-24. [PMID: 18776998 DOI: 10.1007/s00392-008-0712-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Telemedical ICD monitoring has the potential to enhance patient safety. The "home-monitoring" (HM) feature transmits selected device-related data to a service-center via mobile phone network. In case of a potential emergency situation, event reports are generated automatically. This prospective observational study was designed to test whether HM is effective and reliable in early detection of device failure. METHODS Consecutive patients receiving ICD, CRT-D or CRT pacemaker systems with HM feature were included. Regular follow-up visits were performed 1, 3, 6, 9 and 12 months after implantation in the first year, and every 6 months thereafter. All event reports transmitted by HM were analyzed and severe device-related events (serious lead or device dysfunction, hospitalization, death) were documented including timing, type and mode of detection. RESULTS Sixty-nine patients were included and followed for 18 +/- 9 months. A total of 206 event reports were transmitted, prompted by VF/VT-episodes (n = 193), ineffective ICD shocks (n = 7), abnormal pacing impedance (n = 4) or battery depletion (n = 2). 8 SAEs were observed (RV lead fracture; n = 5, connector defect; n = 1, sensing defect, n = 1, RV lead dislodgement, n = 1). There was no device-related death. 6 out of 8 SAEs were discovered by HM (sensitivity, 75%). Without HM, these events would have been detected with a theoretical delay of 1.9 +/- 0.5 months in the first year (3 monthly FU) and 4.9 +/- 0.5 months in the following years (6 monthly FU). CONCLUSIONS This pilot study demonstrates that HM enables early detection of ICD failure and appears to enhance patient safety.
Collapse
Affiliation(s)
- Melanie Hauck
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
20
|
Raatikainen MJP, Uusimaa P, van Ginneken MME, Janssen JPG, Linnaluoto M. Remote monitoring of implantable cardioverter defibrillator patients: a safe, time-saving, and cost-effective means for follow-up. Europace 2008; 10:1145-51. [PMID: 18703585 PMCID: PMC2552405 DOI: 10.1093/europace/eun203] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims The purpose of this prospective study was to investigate whether internet-based remote monitoring offers a safe, practical, and cost-effective alternative to the in-office follow-up visits of patients with an implantable cardioverter defibrillator (ICD). Methods and results Forty-one patients (62 ± 10 years, range 41–76, 83% male) with previously implanted ICD were followed for 9 months. One-hundred and nineteen scheduled and 18 unscheduled data transmissions were performed. There were no device-related adverse events. Over 90% of the patients found the system easy to use. Physicians reported the system as being ‘very easy’ or ‘easy’ to use and found the data comparable to traditional device interrogation in 99% of the cases. They were able to address all unscheduled data transmissions remotely. Compared with the in-office visits, remote monitoring required less time from patients (6.9 ± 5.0 vs. 182 ± 148 min, P < 0.001) and physicians (8.4 ± 4.5 vs. 25.8 ± 17.0 min, P < 0.001) to complete the follow-up. Substitution of two routine in-office visits during the study by remote monitoring reduced the overall cost of routine ICD follow-up by 524€ per patient (41%). Conclusion Remote monitoring offers a safe, feasible, time-saving, and cost-effective solution to ICD follow-up.
Collapse
Affiliation(s)
- M J Pekka Raatikainen
- Division of Cardiology, Department of Internal Medicine, University of Oulu, PO Box 5000, 90014 Oulu, Finland.
| | | | | | | | | |
Collapse
|
21
|
Abstract
The major device manufacturers have introduced systems for remote patient monitoring. These remote monitoring systems promise more efficient patient management, especially in today's clinical setting with the growing number of defibrillator implantations. The aim of this article is to present the role of remote patient monitoring in implantable cardioverter-defibrillator follow-up, its potential benefits and its barriers to widespread diffusion. (Neth Heart J 2008;16:53-6.).
Collapse
Affiliation(s)
- D A M J Theuns
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | |
Collapse
|
22
|
Brugada P. What evidence do we have to replace in-hospital implantable cardioverter defibrillator follow-up? Clin Res Cardiol 2007; 95 Suppl 3:III3-9. [PMID: 16598602 DOI: 10.1007/s00392-006-1302-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Due to the increasing number of patients with an implantable cardioverter defibrillator (ICD), new options for ICD patient follow-up management are required. METHODS Patients with ICD indication according to the guidelines received an ICD with Home Monitoring technology. The devices enabled the transmission of the relevant episode, therapy, and system integrity data. Patients were followed for 12 months with routine controls every 3 months. The physician analyzed the Home Monitoring data before the routine follow-up visit (FU) and gave a forecast on the necessity of the pending FU, which was compared with the evaluation after the FU. Based on the derived forecast reliability, a patient management scheme was developed and its impact on patient safety was assessed retrospectively. RESULTS A total of 271 patients were enrolled (40 f, mean age 62+/-12 years, mean LVEF 39+/-15%, 65% ischemic heart disease, 20% cardiomyopathy) and followed for 339+/-109 days. Of 908 pairs of Home Monitoring data and FU data evaluation, 129 there were false negative results for 92 patients. Safety concerns from false negative forecasts can be minimized with a patient management scheme containing the following elements: 1) never skip the first routine FU; 2) never skip a routine FU for a patient having already shown pacing threshold problems; 3) perform FU following hospitalizations; 4) perform FU following episode detection by the ICD; and 5) perform a routine FU if the patient reports symptoms. The retrospective analysis showed, that if the patients had been managed using this scheme, 503 of 1079 routine FU could have been skipped with only one safety concern, a three month delay in the detection of silent paroxysmal atrial fibrillation in one patient. CONCLUSIONS Home Monitoring in ICD therapy over 12 months is feasible. The data transmitted relevantly contribute to a remarkable reduction of follow-up burden and enable the individualization of routine follow-up.
Collapse
Affiliation(s)
- P Brugada
- O. L. V. Hospital, Cardiovascular Center, Moorselbaan 164, 9300 Aalst, Belgium
| |
Collapse
|
23
|
Zartner PA, Handke RP, Brecher AM, Schneider MBE. Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl. ACTA ACUST UNITED AC 2007; 9:192-3. [PMID: 17289806 DOI: 10.1093/europace/eum003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.
Collapse
Affiliation(s)
- P A Zartner
- German Paediatric Heart Centre Sankt Augustin, Department for Cardiology, Arnold-Janssen-Str. 29, D-53757 Sankt Augustin, Germany.
| | | | | | | |
Collapse
|
24
|
Toft E. Implantable electrocardiographic monitoring--clinical experiences. J Electrocardiol 2006; 39:S47-9. [PMID: 17015068 DOI: 10.1016/j.jelectrocard.2006.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Egon Toft
- Department of Cardiology, Aalborg Hospital, Arhus University Hospitals, 9000 Aalborg, Denmark.
| |
Collapse
|
25
|
Amara W, Sergent J. [Pacemakers and defibrillators: what should we know about home monitoring?]. Ann Cardiol Angeiol (Paris) 2006; 55:315-20. [PMID: 17191589 DOI: 10.1016/j.ancard.2006.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Cardiac stimulators and defibrillators dispose of diagnostic capabilities. Home monitoring permits to have information about the cardiac rhythm of the patient and about the function of the pacemaker or the defibrillator. Technical aspects, safety and legal issues of home monitoring are discussed in this article.
Collapse
Affiliation(s)
- W Amara
- Unité de stimulation cardiaque, CHI Le Raincy-Montfermeil, 10, rue du General-Leclerc, 93370 Montfermeil, France.
| | | |
Collapse
|
26
|
Res JCJ, Theuns DAMJ, Jordaens L. The role of remote monitoring in the reduction of inappropriate implantable cardioverter defibrillator therapies. Clin Res Cardiol 2006; 95 Suppl 3:III17-21. [PMID: 16598599 DOI: 10.1007/s00392-006-1304-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) with the integrated Home Monitoring feature use dedicated mobile phone and internet links to provide the physicians and technicians in the ICD clinic with the essential device- and arrhythmia-related data stored in the ICD diagnostic memory. Various counters, graphs and intracardiac electrograms are automatically transmitted via Home Monitoring each day to allow prompt, remote presentation of arrhythmias or detection of technical problems. One of the most inconvenient side-effects of the ICD therapy is inappropriate intervention of the device. Home Monitoring data can help the physician to identify and subsequently reduce the incidence of inappropriate ICD therapy.
Collapse
Affiliation(s)
- J C J Res
- Department of Electrophysiology, Erasmus Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
| | | | | |
Collapse
|
27
|
Perings C, Korte T, Trappe HJ. IEGM-online based evaluation of implantable cardioverter defibrillator therapy appropriateness. Clin Res Cardiol 2006; 95 Suppl 3:III22-8. [PMID: 16598600 DOI: 10.1007/s00392-006-1305-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Appropriate and inappropriate therapies of implantable cardioverter defibrillators have a major impact on morbidity and quality of life in ICD recipients. Intracardiac electrograms (IEGMs) stored in the ICD have been shown to be essential for differentiating appropriate and inappropriate ICD therapies. The recently introduced third generation of ICD Home Monitoring offers remotely transmitted IEGMs (IEGM-online). Hence, the appropriateness of ICD therapies might be remotely assessed. Validation of these electrograms is currently being performed in the RIONI study. A total of 210 episodes will be collected by about 40 European clinical centers. The study primarily investigates whether the IEGM-online based evaluation of the appropriateness of the ICD's therapeutic decision following a tachyarrhythmia episode detection is equivalent to the evaluation based on the complete ICD episode holter. The evaluation is independently performed by an expert board of three experienced ICD investigators. The equivalence of the two methods is accepted if the conclusions deviate for less than 10% of all evaluated IEGMs. Secondary endpoints investigate the IEGM-online usefulness in more detail. The conclusion of the study is expected by mid of 2007. RIONI has successfully been started for proving the reliability of IEGM-online. The expected results will significantly influence the efficacy of Home Monitoring based patient management.
Collapse
Affiliation(s)
- C Perings
- Medizinische Klinik II, Ruhr-Universität Bochum, Marienhospital Herne - Klinik Mitte, Hölkeskampring 40, 44625 Herne, Germany.
| | | | | |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW The aim of this article is to forecast a major imminent change in the clinical practice of cardiac rhythm management, which is argued to be remote patient monitoring, its potential benefits to clinical practitioners and its barriers to widespread diffusion. RECENT FINDINGS All four major manufacturers of cardiac rhythm management devices have recently introduced varying types of systems that allow remote patient monitoring. These remote patient monitoring systems promise more efficient patient management in today's clinical setting of rapidly growing numbers of patients with increasingly heterogeneous etiology, varying indications and comorbidities. The major differences between current systems are related to the degree of patient involvement in remote patient monitoring and limits on patient mobility. Other important factors that influence the value of remote patient monitoring are the degree to which remote follow-up would completely fulfill the requirements of an in-office follow-up and the inclusion of sensors that enable the prediction of major clinical events such as heart failure decompensation with a high degree of accuracy. SUMMARY Even if the different remote patient monitoring systems currently available offer several clinical benefits such as early detection of cardiac events and complications, reduced follow-up costs and increased safety, the full potential of such systems requires the possibility to easily transfer relevant patient data to common patient databases that are linked to hospital information systems or electronic patient records. Only then will it be possible to gain a complete picture of patient conditions. This will require the development of common protocols for data communication and may involve issues of patient data ownership and integrity.
Collapse
|
29
|
Jung W, Birkemeyer R. [Home Monitoring with implantable ICD--a diagnostic innovation?]. Herzschrittmacherther Elektrophysiol 2005; 16:183-90. [PMID: 16177945 DOI: 10.1007/s00399-005-0484-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 08/17/2005] [Indexed: 05/04/2023]
Abstract
In recent years the rate of ICD implantation has grown substantially after the results of primary and secondary prevention trails have shown significant improvement in mortality and morbidity. However, the increasing number of patients with ICD indication leaves the implanting centres with large logistic problems, esp. with the number of follow-up visits. To further ensure high quality standard in therapy management new follow up routines have to be considered. Possible help may come with new methods of telecardiology, which are presently being introduced into clinical practice. Those systems differ in the way that they are capable to substitute a routine follow up and/ or deliver continuous diagnostic and device status information. Maybe the most promising solution is Home Monitoring in which the implant sends automatically daily messages with regard to therapy and ICD/CRT status without any cooperation of the patient. Interaction of the physician can be triggered by patient individual event filter. By utilizing this features in combination with event related IEGM Online Data physician are able to guide patients more effectively.
Collapse
MESH Headings
- Defibrillators, Implantable
- Diagnosis, Computer-Assisted/instrumentation
- Diagnosis, Computer-Assisted/methods
- Diagnosis, Computer-Assisted/trends
- Electrocardiography, Ambulatory/instrumentation
- Electrocardiography, Ambulatory/methods
- Electrocardiography, Ambulatory/trends
- Germany
- Heart Diseases/diagnosis
- Heart Diseases/prevention & control
- Home Care Services
- Systems Integration
- Technology Assessment, Biomedical
- Telemedicine/instrumentation
- Telemedicine/methods
- Telemedicine/trends
- Therapy, Computer-Assisted/instrumentation
- Therapy, Computer-Assisted/methods
- Therapy, Computer-Assisted/trends
Collapse
Affiliation(s)
- W Jung
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, 2103, 78050 Villingen-Schwenningen.
| | | |
Collapse
|
30
|
Koos R, Sinha AM, Stellbrink C. Home Monitoring in an ICD patient with incessant ventricular tachycardia. ACTA ACUST UNITED AC 2005; 94:461-4. [PMID: 15997347 DOI: 10.1007/s00392-005-0244-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Accepted: 01/28/2005] [Indexed: 11/24/2022]
Abstract
Due to the increasing number of patients and complexity of modern tachycardia devices, efficient therapy surveillance as offered by Home Monitoring (HM) is of increasing importance. We report of an ICD patient with incessant ventricular tachycardia, in whom immediate arrhythmia transmission by HM permitted hospitalization and change of medication without time delay.
Collapse
Affiliation(s)
- R Koos
- Medizinische Klinik I der RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
| | | | | |
Collapse
|
31
|
Schoenfeld MH, Reynolds DW. Sophisticated Remote Implantable Cardioverter‐Defibrillator Follow‐Up: A Status Report. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:235-40. [PMID: 15733185 DOI: 10.1111/j.1540-8159.2005.09554.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mark H Schoenfeld
- Hospital of Saint Raphael, Yale University School of Medicine, New Haven, CT 06511, USA.
| | | |
Collapse
|