title: Remote monitoring of patients with biventricular defibrillators through the CareLink system improves clinical management of arrhythmias and heart failure episodes.
abstract: 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.
authors.affiliation: Department of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, 00135 Rome, Italy. m.santini@rmnet.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Renato P
authors.initials: RP
authors.lastname: Ricci
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Perego
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marzegalli
authors.forename: Milena
authors.initials: M
authors.lastname: Schirru
authors.forename: Chiara
authors.initials: C
authors.lastname: Belvito
authors.forename: Roberto
authors.initials: R
authors.lastname: Brambilla
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guenzati
authors.forename: Serena
authors.initials: S
authors.lastname: Gilardi
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
mesh_terms: 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