Contributions of remote monitoring to the follow-up of implantable cardioverter-defibrillator leads under advisory.
OBJECTIVE
Automatic daily transmission of data from implantable cardioverter-defibrillators (ICDs) enables the remote monitoring of device status and leads function. We report on a 2-year experience with remote monitoring in 40 recipients of high-voltage ICD leads, prone to fracture and under advisory since October 2007.


RESULTS
The ICDs were remotely monitored as well as systematically interrogated in the ambulatory department every 3 months. The patients were also seen in case of abnormal lead impedance, or other manifestations consistent with lead dysfunction. Over a mean follow-up of 22 ± 4 months after ICD implantation, four lead dysfunctions were suspected because of remotely transmitted oversensing of noise artifacts, abrupt rise in pacing impedance, or both. A lead fracture needing lead replacement was confirmed in three patients (7.5%), two of them before any inappropriate therapy and one after the delivery of three inappropriate shocks. No lead failure was observed in the remaining 36 patients, either at the time of ambulatory visits or during remote monitoring.


CONCLUSIONS
Remote monitoring allowed the early and reliable detection of ICD leads failure without requiring any patient intervention.
Guédon-Moreau
Laurence
L
Hôpital Cardiologique, Centre Hospitalier Régional Universitaire, 59 boulevard Leclerq, F-59037 Lille cedex, France. laurence.guedon@chru-lille.fr
Chevalier
Philippe
P
Marquié
Christelle
C
Kouakam
Claude
C
Klug
Didier
D
Lacroix
Dominique
D
Brigadeau
Francois
F
Kacet
Salem
S
D000368:Aged; D017147:Defibrillators, Implantable / Q000592:standards*; D004556:Electric Injuries / Q000209:etiology; D004562:Electrocardiography; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000628:therapy; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D011475:Prosthesis Failure; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry / Q000379:methods