title: Incidence and predictors of pacemaker reprogramming: potential consequences for remote follow-up.
abstract: OBJECTIVE
  Remote follow-up (FU) enables to cope with the expanding number of pacemaker (PM) FU. Although remote FU offers comparable monitoring options to in-office FU, reprogramming of device settings is not available, thereby imposing a potentially important restriction to the applicability of remote FU.  The aim of this study was to assess in a large cohort of bradycardia PM recipients, the incidence of PM reprogramming during long-term FU and its predictors, to judge the possibilities for remote FU.
  
  
  RESULTS
  Between 2003 and 2010 all in-office FU of 1517 bradycardia PM recipients included in the FOLLOWPACE study were recorded. Only 24.5% of all 13 258 recorded FU visits >3 months after implantation were visits-with-reprogramming (VWRs), occurring in 1158 patients (79%). Fifty percent of patients were free of reprogramming at 9 months, and 29% at 24 months. Using multivariable binary logistic regression analysis, the following patient characteristics were predictive for frequent PM reprogramming, defined as >3 VWRs during 3 year FU: age, a history of atrial arrhythmias, PM complication <3 months after implantation, congestive heart failure, PM indication, and lead fixation method. This model had a receiver operating characteristic area of 0.66 (95% confidence interval 0.61-0.71).
  
  
  CONCLUSIONS
  This study observed a low proportion of VWR (∼25%) during a mean FU of 5.3 years; however, those patients at high risk for PM reprogramming cannot easily be predicted. The vast majority of patients (>80%) do not need frequent reprogramming, suggesting a potential benefit of using remote FU to reduce the number of unnecessary in-office visits.
authors: Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands. e.o.udo@umcutrecht.nl
authors: Erik O
authors: EO
authors: Udo
authors: Norbert M
authors: NM
authors: van Hemel
authors: Nicolaas P A
authors: NP
authors: Zuithoff
authors: Mike J
authors: MJ
authors: Barrett
authors: Jaap H
authors: JH
authors: Ruiter
authors: Pieter A
authors: PA
authors: Doevendans
authors: Karel G M
authors: KG
authors: Moons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001919:Bradycardia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome
keywords: Pacemaker; Remote follow-up; Reprogramming