176-40: Device-based parameter telemonitoring of patients with pacemaker, ICD and CRT systems: the Home Ambulance pilot study

Abstract

Purpose: The manufacturers of the devices have developed applicable solutions for concepts of care including telemedical monitoring of patients with PM, ICD and CRT systems. The aim of this study was to describe the daily routine application of a new telemonitoring system in a large ambulatory population of cardiac device patients. Methods: Data transmitted daily and automatically by a remote, wireless Home Monitoring system were analyzed. The monitoring center informed via fax the implanting and follow-up center. The mean interval between device interrogations was used to compare the rates of follow-up visits versus that recommended in guidelines. Summary of results: This retrospective analysis evaluates telemetric data obtained from 329 patients in single-center over the last 3 years, which were assigned to telemonitoring group (n = 147) and to control group (n = 182). Mean age was 65.5 years and most patients received PM (n = 230; 70%). Mean follow-up was 2.7 years. During the telemedical monitoring in patients with PM we detected episodes of silent atrial fibrillation (n = 50) and ventricular tachycardia (n = 8) offers the possibility of faster reaction to electrophysiological studies including ablation, programming changes or upgrade of cardiac devices, and medication changes. Approximately 17% of emergency messages arrived within 4 weeks of implantation and reported acute changes in lead parameters (abnormal sensing and impedance (n = 20) and lead dysfunction/dislocation (n = 9)), which required medical intervention. At the same time, the outpatient follow-ups can be reduced without negatively affecting safety or quality of life. In five CRT patients cardiac decompensation were unreported and only detected by telemonitoring. Conclusions: The telemedical monitoring of patients with PM, ICD and CRT systems facilitates new opportunities to intensify follow-up visit in the early (30 days) postoperative phase, in order to improve the cardiac device therapy, which enhances patient's safety. At the same time telemonitoring can provide a valid support for detection of implant-based problems in longterm follow-up and comprehensive medical treatment.