title: Home monitoring of implantable cardioverter-defibrillators: interpretation reliability of the second-generation "IEGM Online" system.
abstract: OBJECTIVE
  Intracardiac electrograms (IEGMs) are essential for the assessment of implantable cardioverter-defibrillator (ICD) function. The Biotronik Home Monitoring systems transmit an 'IEGM Online' that is shorter than the full-length programmer IEGM due to technical constrains. The aim of this study was to evaluate the accuracy of the physician's classification of the underlying rhythm based on the second-generation IEGM Online.
  
  
  RESULTS
  In total, 1533 patients treated with single- and dual-chamber ICDs and cardiac resynchronization therapy defibrillators were enrolled at 67 investigational sites and followed for 15 months. The investigators classified the rhythm shown in IEGM Online as ventricular tachycardia, ventricular fibrillation, atrial fibrillation, other supraventricular tachyarrhythmia, oversensing due to lead failure, T-wave oversensing, or other rhythm. At the next in-office follow-up, the investigators classified independently the rhythm seen in the corresponding programmer IEGM. The two rhythm classifications were compared thereafter. Both IEGM Online and programmer IEGM were available in 2099 arrhythmic or oversensing events, of which 146 (7.0%) were classified as other rhythm or artefacts and were excluded as inconclusive or atypical. The remaining 1953 events, affecting 352 patients (23.0%), were classified correctly in 1803 cases (92.3%). The accuracy of rough rhythm classification as ventricular, supraventricular, or oversensing was 97.2%.
  
  
  CONCLUSIONS
  The Lumax and IEGM Online HD Evaluation study demonstrates that remote IEGM analysis is reasonably accurate in a remote monitoring system that transmits shorter IEGM than the full-length programmer IEGM for the sake of frequent, fully automatic data transmission.
authors.affiliation: Medical Clinic, Hospital Reinbek St. Adolf Stift, Reinbek, Germany herbert.naegele@albertinen.de.
authors.forename: Herbert
authors.initials: H
authors.lastname: Nägele
authors.affiliation: St. Anne's University Hospital and International Clinical Research Center, Brno, Czech Republic.
authors.forename: Jolana
authors.initials: J
authors.lastname: Lipoldová
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Oswald
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Klein
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
authors.affiliation: Evangelisches Krankenhaus, Düsseldorf, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Vester
authors.affiliation: Department of Internal Medicine I and Comprehensive Heart Failure Centre, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bauer
authors.affiliation: Charité - University Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: Hansjürgen
authors.initials: H
authors.lastname: Bondke
authors.affiliation: Department of Cardiology, Städtisches Klinikum München-Bogenhausen, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Reif
authors.affiliation: Elisabeth-Krankenhaus, Recklinghausen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Daub
authors.affiliation: Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Menzel
authors.affiliation: Biotronik SE and Co. KG, Berlin, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schrader
authors.affiliation: Department of Internal Medicine, LKH Bruck an der Mur, Bruck an der Mur, Austria.
authors.forename: Göran
authors.initials: G
authors.lastname: Zach
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000628:therapy*; D017147:Defibrillators, Implantable; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009862:Online Systems; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: Arrhythmia detection; Home monitoring; Implantable cardioverter-defibrillator; Intracardiac electrogram; Remote monitoring; Telemedicine