Timely notice by Home Monitoring (HM) of multiple asymptomatic self-terminating ventricular ar­rhytmia recurrences in a patient with lmplantable Cardioverter Defibrillator (lCD)

D. Melissano, F. De Santis, A. Marzo, G. Pettinati

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

IXth Southern Symposium on Cardiac Pacing. (Giardini Naxos 29 september - 2 october 2005) Reprints from: Mediterranean Journal of Pacing and Electrophisyology. Volume 6, n.2, 2004

Self-terminating ventricular tachyarrhytmias (STVTs) were occasionally reported as one of possible complica­tions in patients with lCD, causing useless battery consumption, due to aborted capacitor charges, and even inap­propriate shocks. The recently introduced Home Monitoring (HM) technology (Biotronik GmbH, Germany) pro­vides a remote and continuous device control and can be effective in timely managing and preventing ICD compli­cations. This report shows a case in wich HM service immediately informed physicans in charge of multiple recur­rences of asymptomatic STVT episodes, causing a large number of aborted shocks, that could have substantiallv re­duced lCD longevity.

 Case Report

 M.M. a 60 year old man affected by ischemic dilatative cardiomyopaty and multiple aorto-coronaryc by pass, pre­sented frequent episodes of susteined ventricular tachicardya and received a Biotronik Belos DRT ICD, with a mo­bile unit, comprising both features of daily retrieving data from the implanted device through a wireless receiver for long distance (about two meters) telemetry and forwarding such information to a unique service centre by connecting with GSM net. The service centre envoyed cardio-report forms by fax at our cardiologist in charge of the patient dai­ly on first month and successively once per week. During seven months follow up the device reported 2 episodes of TV — FV interrupted by appropriate and efficacious shoscks. Then, after eigth months, the cardioreport immediately reported many episodes of asymptomatic STVTs 180 b/min. during fews seconds (8-14 sec.) causing charging process and aborted shocks. This episodes where in total 48, mean 3-5 daily. Our cardiologist advised by HM forms reporting of these repeated events recalled the patients for therapy adjustament and device reprogramming. In the present case, the implementation of this technology prevented from inappropriate shocks, despite the large number of STVTs and avoided, by early intervention for ICD reprogramming, the battery consuming aborted charging cycles.