Technical and practical aspects of remote monitoring of implantable cardioverter-defibrillator patients in Poland - preliminary results.
BACKGROUND
The aim of remote monitoring of implantable cardioverter-defibrillators (ICD) is to increase the patient's safety by early detection of technical or medical malfunctions and decrease the number of follow-up visits.


OBJECTIVE
To evaluate the feasibility and reliability of internet-based home monitoring of ICD recipients in Poland.


METHODS
Twenty-seven patients with ICD with remote monitoring options were evaluated; 20 (74%) patients had a single chamber ICD, 6 (22%) patients had a dual chamber ICD and one had an ICD with a resynchronisation therapy option. Medical and technical events reported by the remote monitoring system as well as interruptions in monitoring longer than 14 days were analysed.


RESULTS
The patients were followed for 12.7 +/- 10.5 months. Two of them died because of heart failure (6 and 13 months after ICD implantation, respectively). The remote monitoring system reported medical events in 13 (48%) patients. In total, we received 32 event reports (from 1 to 19 per patient, mean 2.6) which were generated due to the detection of ventricular tachycardia (VT) (17 events in 9 patients), ventricular fibrillation (VF) (9 episodes in 6 patients), ineffective defibrillation with the maximal energy (5 reports in 3 patients) and supraventricular tachycardia in the VT detection window (1). Two patients had more than 3 VT/VF episodes during 24 h. There were no reports on technical abnormalities of the ICD system. Interruptions in home monitoring longer than 14 days occurred in 5 (18.5%) patients and lasted 2 to 14 weeks (mean 2.8 +/- 7.1). The longest break was caused by the patient's stay abroad. The remaining interruptions were caused by: journeys (5 episodes), hospitalisations (4), and a temporary stay in a place without sufficient GSM coverage (3). During the follow-up period there were no interruptions in monitoring caused by transmitter or ICD failure. All data received by the home monitoring system were confirmed during the follow-up visits.


CONCLUSIONS
Remote monitoring of ICD recipients in Poland does not present technical difficulties and enables early detection of serious events in ICD patients.
Przybylski
Andrzej
A
Institute of Cardiology, 04-628 Warsaw, Poland. aprzybylski@ikard.pl
Zakrzewska-Koperska
Joanna
J
Maciag
Aleksander
A
Derejko
Paweł
P
Orczykowski
Michał
M
Szumowski
Lukasz
L
Walczak
Franciszek
F
D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017147:Defibrillators, Implantable; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications* / Q000628:therapy*; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006701:Home Nursing / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013686:Telemetry / Q000379:methods*