title: Management of alert messages in the remote monitoring of implantable cardioverter defibrillators and pacemakers: an Italian single-region study.
abstract: OBJECTIVE
  The remote monitoring of pacemakers and implantable cardioverter defibrillators (ICDs) promotes accurate supervision of the patient and device. Alert settings appear to be a crucial parameter of its efficacy. The purpose of our study was to evaluate various settings for alerts and alert message management in patients with pacemakers and ICDs.
  
  
  RESULTS
  We prospectively evaluated 282 patients (181 males, 101 females, mean age 72 ± 11 years) who were referred to nine electrophysiological centres in the Veneto region of Italy for a pacemaker (76 patients) or ICD (206 patients) implant in which remote monitoring was activated (Biotronik Home Monitoring®, Biotronik, Berlin, Germany). During a mean follow-up of 382 ± 261 days, we received 106,039 transmissions. In the pacemaker group, the alerts that were most frequently activated were those concerning battery exhaustion, surveying impedances, sensing and threshold measurements, as well as missing transmissions. In the ICD/ICD-cardiac resynchronization therapy group, the alerts nearly always activated were those concerning a detection setoff, battery exhaustion, critical values of impedance, or ineffective maximum energy shock. In both groups, the alarms for heart rate monitoring and supraventricular arrhythmia were activated in fewer cases at higher variability among centres.
  
  
  CONCLUSIONS
  Our study demonstrates that more attention is paid to critical technical data than to patients' clinical profiles, probably to limit an excessive flow of data into the centre. Accurate alert settings, personalized to the patients' features, are essential for easier and more effective management of patients who are followed remotely.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2-35128 Padova, Italy. franco.folino@unipd.it
authors.forename: Antonio Franco
authors.initials: AF
authors.lastname: Folino
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiusso
authors.forename: Gabriele
authors.initials: G
authors.lastname: Zanotto
authors.forename: Diego
authors.initials: D
authors.lastname: Vaccari
authors.forename: Gianni
authors.initials: G
authors.lastname: Gasparini
authors.forename: Antonella
authors.initials: A
authors.lastname: Megna
authors.forename: Elena
authors.initials: E
authors.lastname: Marras
authors.forename: Roberto
authors.initials: R
authors.lastname: Mantovan
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vaglio
authors.forename: Gabriele
authors.initials: G
authors.lastname: Boscolo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Biancalana
authors.forename: Loira
authors.initials: L
authors.lastname: Leoni
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Buja
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable; D004633:Emergency Medical Tags; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D058998:Remote Sensing Technology