Remote monitoring of implantable pacemakers and cardioverter defibrillators – management of alert messages

Introduction: Remote monitoring of implantable pacemakers and cardioverter defibrillators allows an attentive, accurate and continuous survailance of the patient. Alert messages are sent for different pre-defined conditions. These messages seem to play a crucial role in the accuracy of remote monitoring. Our aim was to analyze the different types of alert messages and the importance of these messages on the patient management. Methods: We retrospectively evaluated 7 patients in whom remote monitoring was activated (we used Home Monitoring Biotronik, Berlin, Germany): 4 patients (57.14%) with implantable cardioverter defibrillators incorporating resynchronization therapy (CRTD); 1 patient (14.28%) with cardiac resynchronization therapy (CRT-P) and 2 patients (28.57%) with double chamber pacemakers. During a mean follow-up of 794 days we received 532 alert messages. Alert messages were analyzed in maximum 24 hours by a cardiologist. These messages resulted in telephone discussions with the patients and reprogramming the device and/or chan ges in medication. Results: 431 messages (81.01%) were periodic followup messages, 101 messages (18.98%) were triggered by cardiovascular events (84 messages – 83.16%) or by device integrity issues (17 messages – 16.83%). The most frequent arrhythmia transmitted was AF (78 messages – 77.22%). The first AF episode was detected 138 days before the scheduled follow-up visit. There were 3 messages (2.97%) received for sustained VT. The first VT episode was detected 91 days before the scheduled follow-up visit. 2 messages (1.98%) were received for VF (1 ventricular fibrillation episode stopped spontaneously and 1 VF episode was in fact an artefact). 1 message (0.99%) was received for CRT below the limit of 85%. 17 messages (16.83% – all received from 1 patient) were triggered by device integrity issues (shock impedance below the limit of 25 Ω). Conclusions: Remote monitoring of implantable pacemakers/cardioverter defibrillators is highly effective in early detection of both arrhythmic events and device malfunctions. This could have important clinical and therapeutic implications.

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