Remote monitoring – the remote future of ICD?

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The popularity of remote monitoring systems for implantable cardiac rhythm management devices is slowly increasing, according to Vidal Essebag, McGill University, Montreal, Canada.

Speaking to Heartwire at EHRA-Europace 2011 (26-29 June 2011), he said that a 2010 European Heart Rhythm Association (EHRA) study showed that nearly 43% of electrophysiologists expect to remotely monitor most of their patients with a pacemaker and all of their patients with an implantable cardiac defibrillator (ICD) by 2015. He added that only 7% of electrophysiologists would not use remote monitoring at all.

Several studies have shown that remove monitoring is associated with reduced clinic visits with no change in overall safety, shortened hospitalisations, and the early and reliable detection of ICD failure without patient intervention. However, one study found that remote monitoring did not have a significant effect on hospital admission, all-cause mortality, or hospital stay. Thus, more studies are needed to determine whether remote monitoring is an effective alternative to routine in-clinic monitoring.

However, the chair of a session on remote monitoring at Europace 2011 Luca Satini, University of Rome, Italy, said that studies may not need to show that remote monitoring is superior just that it is not inferior. “If we demonstrate that the system is safe and it gets the same results and we know it is better for the patient’s quality of life, then that would be enough would not it?”

Esseberg agreed with this view but added that long-term follow-up of non-inferiority studies would be needed. He told Heartwire “The benefits in the first year might not be as much as the benefits down the road, but if we have a five-year follow-up, we might be more likely to find differences.”

For Esseberg, the issue is not actually receiving the data from a remote monitoring device but being able to record and use it effectively. “If you just have a system for follow-up and you do not have anywhere to put the information or control the information, it is a lot harder to manage. That is the hard part. You can get the data, but what do you do with it? How do you manage it? And how do you integrate data from all the different [device] companies.”

For a more in-depth report on remote monitoring, see the next issue of Cardiac Rhythm News (issue 14).