Remote Monitoring of Implantable Cardioverter-Defibrillator Therapy

Abstract

With increasing awareness of the indications of implantable cardioverter defibrillator (ICD) therapy, the number of patients with ICDs has been growing rapidly. Patient with an ICD require high-quality care and intense follow-up to ensure safe and effective device performance. Given the expanding use and the complexity of these devices, there has been an urgent need to improve the safety and cost-effectiveness of ICD follow-up and to alleviate the burden of the pacemaker clinics. Remote monitoring is quickly becoming the standard of care for surveillance of patients with ICDs and other cardiovascular implantable electronic devices (CIED). Transtelephonic data transmission via analog phone lines has recently been replaced by sophisticated Internet-based, automatic monitoring systems, which enable transmission of ICD performance and therapy data via a mobile monitor located in the patient’s home to a secure server. Within minutes, the data are available to the physician online via a secure Internet access 24/7. Each company employs somewhat different technology and degree of automation in their systems. For several years Biotronik was the only company with fully automatic wireless data transmission, but recently also the other manufactures have developed GSM-based wireless systems. Currently remote monitoring systems are widely used for the surveillance of ICD patients in the USA and Europe and their use in the other parts of the world is increasing rapidly. We were the first to start using the Medtronic CareLink system in Europe in 2004. It has been estimated that at the moment more than 1 000 000 patients with CIEDs around the world are using remote monitoring systems. The technology is evolving toward fully automated wireless remote monitoring systems which allow instantaneous event transmission without any patient involvement and have the ability of rapidly bring to the physician attention all significant data. Recent trials have demonstrated that remote monitoring reduces clinic burden, and permits early detection of patient and device problems, enabling clinically appropriate intervention and an opportunity to enhance patient safety. In this article, we describe the currently available remote monitoring systems (Table 1), review the available evidence in the literature regarding remote ICD follow-up and discuss some unresolved issues. In addition, we provide several examples that clarify the benefits of the remote ICD monitoring.