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

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.