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About Remote Monitoring for Cardiac Pacemakers and Implantable Cardioverters Defibrillators Patients

17 November, 2011 | Cardiac Ultrasound, ICD, Pacemakers

How Remote Cardiac Monitoring Works

Remote monitoring of implantable active cardiac devices involves transmission stored in a patient’s cardiac implant, automatically or by patient-activation, to a receiver in the patient’s home. From the receiver, information is transmitted via a telephone or other network to a server or service center, where the data is published on a secure and dedicated website, which is viewable by the patient’s clinician. In the case of a significant event which requires urgent treatment, the clinician can be alerted by fax, email or short message service.

Disorders of the heart’s conduction system may lead to arrhythmias that are associated with reduced quality of life and sudden cardiac death if untreated. Treatments include pharmacological therapy or direct electrical stimulation. Electrical intervention is delivered via implanted cardiac devices that can stimulate the heart, resynchronize contraction, or deliver intracardiac shocks to terminate lethal rhythms. These devices include permanent pacemakers to treat bradyarrhythmias, implantable cardioverter defibrillators (ICDs) to decrease the risk of sudden cardiac death among high risk patients, and cardiac resynchronization therapy pacemakers and ICDs to alleviate symptoms and decrease mortality for patients with severe heart failure associated with dyssynchronous ventricular contraction.

Wireless Communication Options

In the era of communication technology, new options are now available for following-up patients implanted with cardiac pacemakers and implantable cardioverter defibrillators ICDs. Most major companies offer devices with wireless capabilities that communicate automatically with home receivers-transmitters, which then relay data to the physician, thereby allowing remote patient follow-up and monitoring. These systems can be widely used for remote follow-up, and their adoption is rapidly increasing.

Remote monitoring systems with minimal patient involvement have been developed by the main manufacturers which supply implantable cardiac devices. These remote monitoring systems have the ability to transmit periodic messages and, in some cases, patient-activated messages, via landline or mobile telephone networks. Devices transmit data to a secure server or service center at a scheduled time. This may be daily or at a different regular interval specified by the clinician. Data is viewable by clinicians on secure websites. If a significant event that requires urgent patient treatment is detected, an alert can be sent to the clinician by email, SMS or fax.

The Main Components of Remote Pacemaker and ICD Systems

The main components of remote pacemaker and ICD monitoring systems are:

  • The implanted cardiac devices capable of storing and transmitting data about the device’s functions.
  • All monitoring systems include a remote communication device, which is usually located in a patient’s home. Its function is to receive data from the implant and to transmit the data via a landline or mobile telephone network to a secure server or remote monitoring service center. Some data transfer systems are automated, while others require patient initiation. Data transmission typically last a few minutes, but can be as quick as 10-15 seconds.
  • Facilities for clinicians to access patient data or to receive alerts are also required. Generally, patient data can be accessed anywhere and at any time via a secure website and alerts can be sent via e-mail, fax or short-message service (SMS).

Broad Information for Optimal Patient Care

The specially dedicated network enables patients to transmit data from their implantable device automatically or as instructed by their physician, using the communication device that is connected to the cell phone or the standard telephone line. Within minutes, the patient’s physician and nurses can view the data on a secure Internet Web site. Available information includes arrhythmia episode reports and stored electrograms along with device integrity information, which is comparable to the information provided during an in-clinic device follow-up visit, and provides the physician with a view of how the device and patient’s heart are operating. The system provides an efficient, safe and convenient way for specialty physicians to optimize patient care by remotely monitoring the condition of their patients and, if needed, make adjustments to medication or prescribe additional therapy.

Messages received at the secure server or service center are translated into a report, which can be accessed by clinicians using the internet. Data transferred by email or the internet is encrypted before dispatch, to safeguard patient confidentiality. New data is added to a database as it is received. Some cardiac pacemaker and implantable cardioverters defibrillator manufacturers also have a dedicated secure website for patients to access personalized information about their device and condition. Data can also be sent directly to a hospital’s electronic health records system and merged with patients’ health records.

Some manufacturers’ cardiac implants and pacemakers have the capability to detect a problem, such as atrial fibrillation or a device integrity issue, and (when in range) automatically establish wireless communication with the remote sensor/transmitter in the patient’s home. This in turn automatically sends a message to the secure server or service center and the clinician receives a notification via e-mail, fax or SMS.

Informed Purpose and Limitations

The patient needs to be informed of the purpose and limitations of remote monitoring, such as the fact that it does not replace an emergency service or absence of dealing with alert events outside office hours. Before initiating remote monitoring and follow-up, the patient may be requested to sign a written informed consent stating these points and authorizing transmission of personal data to third parties, respect of privacy, and confidentiality of patient data by device companies should be subjected to strict rules, described in contracts.