Remote monitoring of patients with biventricular defibrillators through the CareLink system improves clinical management of arrhythmias and heart failure episodes.
OBJECTIVE
The aim of the present study is to evaluate if remote monitoring with the CareLink Network may improve clinical management of tachyarrhythmias and heart failure episodes in patients treated with biventricular defibrillators (CRT-D).


METHODS
Patients implanted with CRT-D for more than 6 months received the CareLink monitor and were trained to perform device interrogation. At-home transmissions were scheduled at 2 weeks, 1 and 2 months after training, with a final in-office visit after 3 months.


RESULTS
Sixty-seven patients performed 264 data transmissions. Twenty-three unscheduled data transmissions were requested by the centers after patient contact. Ventricular tachyarrhythmias were reported in nine patients during 16 data reviews. Thirteen data reviews (81%) were performed remotely via CareLink transmissions (nine scheduled and four unscheduled), in seven patients. Of these events, in two cases (15%) in-hospital visits were requested, while in 11 (85%) no action was needed and no additional in-clinic visits were scheduled. During the study period, in 20/28 (71%) intra-thoracic impedance alerts, the patients remotely transmitted their device data. After remote data review, in ten cases drug therapy was adjusted by phone and in four cases no action was needed and the patient reassured. In six episodes an in-hospital extra visit was scheduled. On the whole, in 14 cases (70%), the patient could be managed remotely avoiding a visit to the hospital.


CONCLUSIONS
Our study showed that remote follow-up is an efficient method to manage tachyarrhythmias and heart failure episodes in CRT-D patients. Early reaction to clinical events may improve overall patient care.
Santini
Massimo
M
Department of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, 00135 Rome, Italy. m.santini@rmnet.it
Ricci
Renato P
RP
Lunati
Maurizio
M
Landolina
Maurizio
M
Perego
Giovanni B
GB
Marzegalli
Maurizio
M
Schirru
Milena
M
Belvito
Chiara
C
Brambilla
Roberto
R
Guenzati
Giuseppe
G
Gilardi
Serena
S
Valsecchi
Sergio
S
D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome