Recommendations for post-implant monitoring of patients with cardiovascular implantable electronic devices: where do we stand today?

Abstract

The 2008 Heart Rhythm Society (HRS)/European Heart Rhythm Association (EHRA) consensus document advocated the necessity of monitoring both device function and patient condition post-implantation of a cardiovascular implantable electronic device (CIED). It recommended a regular calendar-based system of follow-up, but lacked supporting data.1 While generating a huge service commitment, the efficacy of this schedule with regard to patient safety, adherence, incidence of unscheduled encounters, and ability for problem detection were unknown at the time of publication. Furthermore, although follow-up could be accomplished by ‘in person or remote’ methods, the comparative efficacy of these respective techniques in achieving follow-up goals had remained untested until recently. Over the last few years large-scale prospective trials have addressed these questions. These are reviewed by Guedon et al. 2 and the results have been revealing. Moreover, based on such recent evidence, the 2012 EHRA/HRS consensus document has strongly advocated for the use of remote monitoring in patients with cardiac resynchronization therapy (CRT).3 Firstly, replacement of scheduled in-person evaluation with remote follow-up was tested. The underlying concept was that the bulk of conventional in-person scheduled evaluations do not trigger any changes in patient management, i.e. are ‘non-actionable’, and hence could be supplanted with remote follow-up.4 When tested, these theories were confirmed in patient populations implanted with pacemakers, implantable cardioverter defibrillators (ICDs), and CRTs.5–7 For example, TRUST results confirmed that actionability of 3 monthly (3, 6, 9, and 12 month) scheduled calendar-based checks (whether conventionally or remotely managed) was low (<10%), thus replaceable with remote …