Remote monitoring of cardiac implantable devices in the Asia-Pacific

Abstract

Remote monitoring of pacemakers and implantable cardioverter defibrillators (ICDs) has emerged as a tool to replace regular follow-up of such devices, and to detect hardware failure, arrhythmias, and heart failure decompensation. The Asia-Pacific region is a geographically diverse area, with widely different cardiac device implant rates and expertise. However, common to all countries, distance and logistic for patients to reach an expert monitoring centre for routine follow up are significant, and in some countries, this will likely be replaced by remote monitoring. Unscheduled visits such as for the treatment of atrial fibrillation and ICD shocks will be expedited. There has been an increase in both pacemaker and ICD implant rates in Asia-Pacific, due to an ageing population and improvement in economic condition. Among the countries, Australia and Japan are the major users of remote monitoring. According to the statistics of the suppliers, in Australia, up to 15% of pacemakers, 40% ICD, and 30% cardiac resynchronization therapy (CRT)/cardiac resynchronization therapy defibrillator (CTRD) are remotely monitored. The corresponding numbers for Japan are 5, 50, and 50% respectively. The monitoring personnel include nurses, technicians, and doctors, either from local centre or from device companies. Cost, lack of reimbursement, and logistic support are major issues in widespread application of remote monitoring technology. In conclusion, remote monitoring is increasing in Asia-Pacific region despite the increase in cost. Implantable cardioverter defibrillators and CRT/CRTDs are more likely than pacemakers to be enabled with remote monitoring.