1
|
Gill J. Implantable Cardiovascular Devices: Current and Emerging Technologies for Remote Heart Failure Monitoring. Cardiol Rev 2023; 31:128-138. [PMID: 35349243 DOI: 10.1097/crd.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Heart failure remains a substantial socioeconomic burden to our health care system. With the aging of the population, the incidence is expected to rise in the ensuing years. Standard heart failure management strategies have failed to reduce hospitalizations and mortality. In patients with heart failure, remote hemodynamic monitoring with implantable devices provides essential data, which can be used in unison with standard patient management to reduce heart failure hospitalizations. This review will chronicle the important clinical trials of various implantable devices and describe the emerging technologies in remote heart failure management. Cardiovascular implantable electronic devices, namely implanted cardioverter-defibrillator and cardiac resynchronization therapy devices with defibrillator, have evolved beyond sole resynchronization and currently can deliver real-time cardiac hemodynamics. Clinical data regarding hemodynamic monitoring with implanted cardioverter-defibrillator and cardiac resynchronization therapy devices with defibrillator have not consistently demonstrated a reduction in heart failure or mortality benefit. However, there is promise in the future with the application of multiparameter diagnostic algorithms with these devices. The most efficacious implantable device has been the pulmonary artery pressure sensor, CardioMEMS. This device has been proven to be safe and shown to reduce heart failure hospitalizations. Moreover, multiple newly developed devices are currently under investigation after successful first-in-man studies.
Collapse
Affiliation(s)
- Jashan Gill
- From the Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Department of Medicine, Northwestern McHenry Hospital, McHenry, IL
| |
Collapse
|
2
|
Kazmi SHA, Datta S, Chi G, Nafee T, Yee M, Kalia A, Sharfaei S, Shojaei F, Mirwais S, Gibson CM. The AngelMed Guardian ® System in the Detection of Coronary Artery Occlusion: Current Perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:1-12. [PMID: 32021496 PMCID: PMC6954830 DOI: 10.2147/mder.s219865] [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: 06/18/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Total ischemic time, which specifies the time from the onset of chest pain to initiation of reperfusion during percutaneous coronary intervention, consists of two intervals: symptom to door time and door to balloon time. A door to balloon time of 90 mins or less has become a quality-of-care metric in the management of ST elevation myocardial infarction (STEMI). While national efforts made by the American College of Cardiology (ACC) and American Heart Association (AHA) have curtailed in-hospital door to balloon time over the years, a reduction in pre-hospital symptoms to door time presents a challenge in modern interventional Cardiology. Early and complete revascularization has been associated with improved clinical outcomes in MI and strategies that may help reduce symptom to door time, and thus the total ischemic time, are crucial. Rapidly evolving ST-segment changes commonly develop prior to ischemia-related symptom onset, and are detectable even in patients with clinically unrecognized silent MIs. Therefore, a highly intelligent ischemia detection system that alerts patients of ST segment deviation may allow for rapid identification of acute coronary occlusion. The AngelMed Guardian® System is a cardiac activity monitoring and alerting system designed for rapid identification of intracardiac ST-segment changes among patients at a high risk for recurrent ACS events. This article reviews the clinical studies evaluating the design, safety and efficacy of the AngelMed Guardian System and discusses the clinical implications of the device.
Collapse
Affiliation(s)
- Syed Hassan Abbas Kazmi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sudarshana Datta
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tarek Nafee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Megan Yee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Akshun Kalia
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sadaf Sharfaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fahimehalsadat Shojaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sabawoon Mirwais
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Palmisano P, Pisanò EC, La Rosa C, Ammendola E, Zaccaria M, Milanese G, Lauretti M, Rillo M, Aloisio A, Rago A, Nigro G, Accogli M. Effectiveness of Implantable DEfibrillators Alert Systems. J Cardiovasc Med (Hagerstown) 2019; 20:114-121. [DOI: 10.2459/jcm.0000000000000745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
4
|
Manandhar M, Nemirovsky D, Feigenblum DY, Simons GR. Investigation of the Utility of the Audible Alert in Recent Generation Medtronic Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1340-1343. [PMID: 27808404 DOI: 10.1111/pace.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/03/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medtronic implantable cardioverter defibrillators (ICDs; Medtronic Inc., Mounds View, MN, USA) are equipped with Patient Alert™, a feature in which the ICD generator emits a series of audible tones to notify patients of possible system malfunction. A prior study of this issue revealed that only 50% of patients with older Medtronic devices were able to hear alerts. More recently, Medtronic has incorporated modifications to the alert. Therefore, we studied how frequently alert tones emitted by the current generation of Medtronic ICDs are audible by patients. METHODS A series of patients were evaluated in an outpatient ICD clinic. Alert tones were demonstrated using a device programmer in a quiet room and in the presence of low-level background noise. Patients reported whether they heard the tones, and they completed questionnaires regarding the tones. RESULTS The total sample size was 100 patients, 81 male, who ranged from 29 years to 94 years of age (mean age 72.1 ± 11.8). Among the study subjects, 46% were older than 75 years, 41% were between 55 years and 75 years, and 13% were younger than 55 years. In the absence of background noise, 94% of patients were able to hear both alerts, 1% heard only one alert, and 5% heard neither. In the presence of background noise, 88% of patients heard both the alerts, 7% heard only one alert, and 5% heard neither alerts. CONCLUSIONS Our results demonstrate that alert tones in recent generation Medtronic ICDs have improved audibility, compared to prior published data, among a large outpatient ICD population.
Collapse
Affiliation(s)
- Meryna Manandhar
- Cardiac Electrophysiology Division, Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
| | - Dmitry Nemirovsky
- Cardiac Electrophysiology Division, Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
| | - David Y Feigenblum
- Cardiac Electrophysiology Division, Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
| | - Grant R Simons
- Cardiac Electrophysiology Division, Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
| |
Collapse
|
5
|
Performance of an ICD algorithm to detect lead noise and reduce inappropriate shocks. J Interv Card Electrophysiol 2016; 45:225-32. [DOI: 10.1007/s10840-015-0081-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
|
6
|
Burri H. Longevity of biventricular defibrillators: not all devices are created equal. Europace 2015; 17:1166-8. [PMID: 26273103 DOI: 10.1093/europace/euv225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Haran Burri
- Electrophysiology Unit, Cardiology Service, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, Geneva 14 1211, Switzerland
| |
Collapse
|
7
|
|
8
|
Abstract
"The Teledactyl (Tele, far; Dactyl, finger--from the Greek) is a future instrument by which it will be possible for us to 'feel at a distance.' This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance...The doctor manipulates his controls, which are then manipulated at the patient's room in exactly the same manner. The doctor sees what is going on in the patient's room by means of a television screen." -Hugo Gernsback, Science and Invention Magazine, February 1925 Heart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor.
Collapse
Affiliation(s)
- Arvind Bhimaraj
- Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
9
|
Verlato R, Facchin D, Catanzariti D, Molon G, Zanotto G, Morani G, Brieda M, Zanon F, Delise P, Leoni L, Comisso J, Campo C. Clinical outcomes in patients with implantable cardioverter defibrillators and Sprint Fidelis leads. Heart 2013; 99:799-804. [PMID: 23434626 DOI: 10.1136/heartjnl-2012-303259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The performances of implantable cardioverter defibrillators and leads are important issues for healthcare providers and patients. In 2007 Sprint Fidelis leads were found to be associated with an increased failure rate and so the purpose of the study was to evaluate long-term mortality and clinical outcomes in patients implanted with Sprint Fidelis leads compared with Sprint Quattro leads. DESIGN, SETTING, PATIENTS 508 patients with Sprint Fidelis leads and 468 with Sprint Quattro leads were prospectively followed in 12 Italian cardiology centres. MAIN OUTCOME MEASURES Information on hospitalisations and other clinical events were collected during scheduled and unscheduled hospital visits. Deaths were identified from medical records or via phone contacts with patients' family members or through the National Office of Vital Statistics. RESULTS Over a mean follow-up of 27±18 months 141 deaths occurred in the overall population. No death was observed in patients with diagnosed failing lead. Kaplan-Meier patient survival differed between the two lead groups (80±2% in Fidelis leads vs 70±4% in the Sprint Quattro leads at 4 years, p=0.002). Multivariate analyses showed that mortality was neither associated with lead type nor with diagnosed failed lead. The annual rate of lead failure was 1.8% patient-year for Fidelis leads and 0.2% for the Sprint Quattro leads. CONCLUSIONS In our multicentre research, the clinical outcomes of patients with Fidelis leads differed from those of patients with Sprint Quattro leads. Nevertheless, neither mortality nor the combined endpoint of mortality and heart failure hospitalisations was associated with the lead type. http://clinicaltrials.gov/ct2/show/NCT01007474.
Collapse
Affiliation(s)
- Roberto Verlato
- Department of Cardiology, General Hospital Cosma, Via P Cosma 1, Camposampiero 35012, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Remote Monitoring for Implantable Cardiac Electronic Devices. Heart Lung Circ 2012; 21:352-7. [DOI: 10.1016/j.hlc.2012.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/08/2012] [Accepted: 03/10/2012] [Indexed: 11/18/2022]
|
11
|
Landolina M, Perego GB, Lunati M, Curnis A, Guenzati G, Vicentini A, Parati G, Borghi G, Zanaboni P, Valsecchi S, Marzegalli M. Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation 2012; 125:2985-92. [PMID: 22626743 DOI: 10.1161/circulationaha.111.088971] [Citation(s) in RCA: 248] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Heart failure patients with implantable cardioverter-defibrillators (ICDs) or an ICD for resynchronization therapy often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers. We hypothesized that Internet-based remote interrogation systems could reduce emergency healthcare visits. METHODS AND RESULTS This multicenter randomized trial involving 200 patients compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events. Over 16 months, such visits were 35% less frequent in the remote arm (75 versus 117; incidence density, 0.59 versus 0.93 events per year; P=0.005). A 21% difference was observed in the rates of total healthcare visits for heart failure, arrhythmias, or ICD-related events (4.40 versus 5.74 events per year; P<0.001). The time from an ICD alert condition to review of the data was reduced from 24.8 days in the standard arm to 1.4 days in the remote arm (P<0.001). The patients' clinical status, as measured by the Clinical Composite Score, was similar in the 2 groups, whereas a more favorable change in quality of life (Minnesota Living With Heart Failure Questionnaire) was observed from the baseline to the 16th month in the remote arm (P=0.026). CONCLUSIONS Remote monitoring reduces emergency department/urgent in-office visits and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. Compared with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00873899.
Collapse
Affiliation(s)
- Maurizio Landolina
- Dipartimento di Cardiologia, Fondazione IRCCS Policlinico San Matteo, P. le Golgi 2, 27100, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Early warning for heart attacks could save many lives. We conducted three studies to design and evaluate multimodal alarms and patient training for an implanted heart attack detector. An implanted device provided vibrotactile alarms subcutaneously, and a pager-like device provided auditory and visual alarms. Temporal alarm patterns connoted an urgent emergency alarm (“Call 911”) and a less urgent alarm (“See your doctor”). In the third, clinical, study, most patients (94%) correctly responded to the alarms at 1, 3, and 6 months after device implantation. Subcutaneous vibrotactile alarms show great potential for use in critical medical applications.
Collapse
|
13
|
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
|
14
|
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.
Collapse
Affiliation(s)
- Sergio Dubner
- Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ricci RP, Pignalberi C, Magris B, Aquilani S, Altamura V, Morichelli L, Porfili A, Quarta L, Saputo F, Santini M. Can we predict and prevent adverse events related to high-voltage implantable cardioverter defibrillator lead failure? J Interv Card Electrophysiol 2011; 33:113-21. [DOI: 10.1007/s10840-011-9612-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/03/2011] [Indexed: 10/17/2022]
|
16
|
Impact of Implanted Recalled Sprint Fidelis Lead on Patient Mortality. J Am Coll Cardiol 2011; 58:278-83. [DOI: 10.1016/j.jacc.2011.03.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/16/2011] [Accepted: 03/15/2011] [Indexed: 11/20/2022]
|
17
|
Bennett MT, Kerr CR, Hahn E, Flavelle S, McIlroy C, Tung SKK. Characteristics of patients and implantable defibrillators associated with failure to sense device alert systems. Europace 2010; 12:1571-3. [DOI: 10.1093/europace/euq313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Lead integrity alert algorithm decreases inappropriate shocks in patients who have Sprint Fidelis pace-sense conductor fractures. Heart Rhythm 2010; 7:1048-55. [DOI: 10.1016/j.hrthm.2010.05.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 05/09/2010] [Indexed: 11/18/2022]
|
19
|
Fischer A. The Lead Integrity Alert beyond Fidelis: The importance of algorithms to reduce inappropriate ICD shocks. Heart Rhythm 2010; 7:1056-7. [DOI: 10.1016/j.hrthm.2010.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Indexed: 10/19/2022]
|