Remote Monitoring of Implantable Cardioverter Defibrillators:

Abstract

A prospective study evaluating the functionality and ease of use of the Medtronic CareLink Network, "CareLink," was conducted at ten investigational sites. This internet-based remote monitoring service allows clinicians to remotely manage their patients' implantable cardioverter defibrillators (ICDs) and chronic diseases. The network is comprised of a patient monitor, a secure server, and clinician and patient websites. Under clinician direction, patients interrogated their ICDs at home, and transmitted data to secure servers via a standard telephone line. Comprehensive device data and a 10-second presenting rhythm electrogram were captured by the monitor and available for access and review on the clinician website. The information could also be printed using a standard desktop computer with internet access. During this study, patients were asked to transmit device data twice, at least 7 days apart, as scheduled by the clinic. Monitor functionality was assessed, and ease of using the system components was evaluated via questionnaires completed by patients and clinicians following each data transmission and review. Fifty-nine patients (64 +/- 14 years, range 22-85 years) completed 119 transmissions with only 14 calls to the study support center. Clinician review of data transmissions revealed several clinically significant findings, including silent AF discovery, assessment of antiarrhythmic drug efficacy in a previously diagnosed AF patient, previously unobserved atrial undersensing, and ventricular tachycardia. ICD patients found the monitor easy to use. Clinicians were pleased with the performance of the network and the quality of the web-accessed data, and found it comparable to an in-office device interrogation. CareLink is a practical tool for routine device management and may allow timely identification of clinically important issues.

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

“…Remote monitoring permits an earlier reaction to events requiring physician intervention in comparison to regular in-office device checks, with 98.6% of transmissions being reviewed within two working days in our cohort. (3,4,6,(14)(15)(16)(17)(18)(19)(20)(21) Early detection allows prompt management of arrhythmias, early management of device malfunction and device reprogramming to reduce inappropriate defibrillator shocks. (18,22,23) Compliance to remote monitoring was good, with an overall missed transmission rate of 11.8%.…”

Remote monitoring in implantable defibrillator therapy

“…As the lead impedance is part of the predefined alerts in remote monitoring, these complications can be detected earlier with remote monitoring than with regular routine follow-up visits. [19][20][21][22] Remote monitoring and clinical data The current generation of ICDs has the capability to track several physiologically diagnostic parameters, such as heart rate, heart rate variability, atrial and 23 showed the possibility to detect the onset of atrial fibrillation with daily monitoring data, which can initiate anticoagulation therapy and /or guide cardioversion. The Home ICD trial demonstrated that remote monitoring resulted in an immediate detection of arrhythmic events, which facilitated an optimised and individualised cardiac rhythm management.…”

E-Health and Telemedicine: Current Situation and Future Challenges

“…This generates an enormous clinical workload which increases further when devices approach ERI, or in response to product advisories and recalls. The application of e-Health and Telemedicine for remote monitoring of patients with implanted devices may provide mechanism(s) for facilitating these tasks [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Data are promising and it can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms.…”