REMOTE CONTROL BY HOME MONITORING SYSTEM (HM) ON IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) PACED PATIENTS.

Pettinati G., Melissano D.

Division of Cardiology – “Ferrari F.” Hospital – Casarano (Italy)

Mediterranean Journal Pacing and Electrophysiology.

Volume 9 n. 1 January - March 2007

Introduction

Home Monitoring (HM) system (Biotronik GmbH, Berlin) is a recently introduced service, that can be optionally activated in specific ICD and Pace Makers (PM). Providing remote control of diagnostic information, collected by the implanted device during its functioning. Information transmission works basing on  a custom mobile phone provided to the patient: it both receives telemetry from the implanted device and transfers data to an automatic service centre in touch with the physician in charge. The system can be send messages every day or week or variable programmed time. Patient plays no role in initiating transmission and can be even unaware of it. The physician can receive reports by fax, e-mail, sms (short message service) message, or accessing in protected internet area according to her/his, preference. At a glance, HM service appears particularly appealing specially for ICD patient management, since some critical events may be potentially catastrophic this kind of patients and a real-time information may prevent from severe complications. A cardio-report from an ICD includes, number of ventricular and supra-ventricular detected episodes, type and outcome of delivered therapies, battery status and pacing and high voltage impedances, ineffective maximal energy shocks. In addition to this periodic reporting, in case of occurrence of pre-selected critical events, the messaging procedure is started immediately and an “event report” is generated.

Materials and methods

We studied 20 patients (90 % male), mean age 70,4 +/- 6 years (50 – 76) affected by ischemic and no-ischemic cardiopathy, sustained ventricular tachycardia, ventricular fibrillation,  NYHA Class II – III – IV (mean class NYHA 2,3 +/- 1,5) E.F. 33,5% +/- 12,2. Implanted patients were n. 12 with ICD “Lumos VRT”, n.4 with ICD + CRT “Kronos”, n. 4 PM “Cylos DRT”. On mean follow –up of 216,5 +/- 186,3 days we verified periodic messages cardio-reports n. 245 (28 patients actived) and n.5 deaths. The monitored patients with happening by constant messages were 15/20 (75%), patients without happening by lack of messages > 15 days were 5/20 (25%), all died. We verified a best control on 6/20 patients (30 %) of events: aborted V.T. parossistyc atrial fibrillation, undersensing, unsuitable energy charge, which demanded  device reprogramming  and improvement of therapy.

Conclusion

Our experience shows the efficacy of the remote control on ICD patient, through HM service, in timely informing physician about repeated and also asymptomatic events preventing further complications. The situations more frequently marked can be: 1) Immediate check of therapy in case of arrhythmic episodes. 2) Increased defibrillation threshold with ineffective maximal shocks. 3) Lead-related complications, pointed out by pacing or shock out of range impedance values, and so on. 4) Reduced number of visit control and decreased discomfort for the patients.

HM service appears a useful and effective too toward this objective