Therapeutic implications of automatic home monitoring of implantable cardiac devices.
Electronic cardiac implants such as pacemakers, cardioverter-defibrillators, and cardiac resynchronization devices improve survival, as evidenced by recent trials for primary and secondary prevention and for cardiac resynchronization therapy. As with other forms of therapy, an important aspect of care is monitoring the patient's condition, response to therapy, and system function. However, practice has been inconsistent. Follow-up schedules vary-for example, from every 3 months to once a year-according to facility, physician preference, and availability of resources. Importantly, no surveillance occurs between follow-up visits. In contrast, implantable devices with remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. Preliminary data from the TRUST (Lumos-T Safely Reduces Routine Office Device Follow Up) study demonstrate that this technology provides a means for efficient monitoring and an opportunity to enhance patient safety by early detection of patient and/or system problems. Remote monitoring likely will become incorporated into the standard of care in cardiac implantable electronic devices.
Niraj Varma, MD, PhD, FRCP Cardiac Electrophysiology Laboratory, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. varman@ccf.org.
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