Abstract
Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs). A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients' quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences). As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients.
Highlights
In the last decades, the advances in information and communication technology have permitted that telehealth supports are diffusing rapidly into all aspects of healthcare
A major problem associated with implantable cardioverter defibrillators (ICDs) therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may be arrhythmogenic
A recent study [6] reports that inappropriate shock occurred in 11.5% of the patients population considered; the inappropriate shocks resulted in 31.2% of the total shock episodes
Summary
The advances in information and communication technology have permitted that telehealth supports are diffusing rapidly into all aspects of healthcare. Atrial fibrillation was the most common trigger for inappropriate shock (44%), followed by supraventricular tachycardia (36%), and by abnormal sensing (20%), which can be due mainly to electromagnetic interferences. Electromagnetic interference may cause erroneous recognition of ventricular fibrillation (VF) and be responsible of inappropriate shocks for implanted defibrillators [7,8,9,10,11,12,13]. Major ICD factories supply their telemonitoring systems such as Home Monitoring (Biotronik); CareLink Network (Medtronic); Latitude Patient Management system (Boston Scientific); Merlin.net (St. Jude Medical). The choice of the GSM network does not force the patient to have a fixed phone or a DSL connection at home; this permits a great freedom of movement during daily life to the patient, ICD monitoring can take place continuously and does not require patient involvement. The types of events which trigger an alert can be customized for each patient
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