Remote Management of Pacemakers and Implantable Defibrillators – Role and Long-term Viability

Haran Burri
European Cardiology 2012;8(2):94–7
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Abstract

Modern pacemakers and implantable defibrillators from all major device companies have wireless capabilities that allow them to automatically communicate data to a transmitter unit installed at the patient’s home, which then relays the data to a secure database. The data are available for consultation by the physician, who can thereby remotely follow-up and monitor both the patient and the device. There is solid evidence showing that remote device follow-up can safely reduce the number of clinic visits. The strategy is well accepted by patients (with advantages such as a reduction in travel and waiting time) and physicians. The remote monitoring of parameters tracking heart failure, arrhythmias or technical issues has the potential to improve patient safety and outcomes. Secondary endpoints of randomised trials indicate that remote device monitoring may reduce the duration of hospital stays and the number of adverse events such as strokes and inappropriate shocks. Reimbursement of remote device monitoring became available in the US in 2006 and more recently in a few European countries. However, to make remote device management viable in the long term, the issue of reimbursement still needs to be addressed by the healthcare authorities of many countries.

Acknowledgement: The author is funded in part by a grant from the La Tour fund for cardiovascular research.
Keywords
Remote device monitoring, telemedicine, implantable cardioverter defibrillator, pacemaker
Disclosure Haran Burri receives fellowship and research grants from Biotronik, Boston Scientific, Medtronic, Sorin and St Jude Medical. He is a member of the Latitude™ Advisory Board.
Received: February 05, 2012 | Accepted March 18, 2012 | Citation European Cardiology 2012;8(2):94–7
Correspondence: Haran Burri, Cardiology Service, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland. E: haran.burri@hcuge.ch

Patients using a pacemaker or implantable cardioverter defibrillator (ICD) require regular follow-up to control the performance and remaining longevity of the device. Traditionally, these device checks have been performed manually during a clinic visit using a dedicated device programmer. In 1971, transtelephonic monitoring was introduced to remotely follow up basic parameters (such as battery status) of pacemakers. Many modern pacemakers and ICDs are able to automatically perform technical checks, such as battery status, lead impedance and sensing and pacing thresholds. With the evolution of communication technologies, remote device management has become available which allows the pacemaker or ICD to transmit such information to the physician. Current guidelines stipulate that the patient should be seen in the clinic at least once a year until battery depletion, with remote management being possible after the initial post-operative follow-up.1

When talking about remote device management, a distinction should be made between remote follow-up (which involves scheduled automatic device interrogations), remote monitoring (which involves automatic unscheduled transmission of event – e.g., onset of atrial fibrillation – alerts) and patient-initiated interrogations (which are non-scheduled follow-ups initiated manually by the patient).2 This article aims to briefly overview the current status of remote device management, which is widely implemented in the US (where it is reimbursed since 2006) and increasingly adopted in Europe.3

Existing Systems

Most major device manufacturers offer a remote monitoring system (see Figure 1), Biotronik being the pioneer in this field. Sorin is in the process of introducing its system, which should be available in Europe in 2012. The various systems function in a similar manner, although they do have technical differences. Older implantable devices require a telemetry wand for manual interrogation by the patient, which is an obvious drawback. Recent implantable devices have an incorporated antenna that allows wireless automatic data transmission to a unit installed at the patient’s home without the need for the patient’s intervention (other than the correct installation of the system). The data are sent to a secure database server via a landline phone or the global system for mobile (GSM) communications network. A message is then sent by email, short message service (SMS) or fax (depending on the system and its configuration) to the physician, who may then consult the data via a secured Internet access. None of the existing systems currently allow the remote programming of devices.

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