title: Technician-Supported Remote Interrogation of CIEDs: Initial Use in US Emergency Departments and Perioperative Areas.
abstract: BACKGROUND
  Interrogation/interpretation of cardiac implantable electronic devices (CIEDs) is frequently required in the emergency department (ED) or perioperative areas (OR) where resources to do this are often not available. CareLink Express (CLE; Medtronic, plc, Mounds View, MN, USA) is a technician-supported real-time remote interrogation system for Medtronic CIEDs. Using data from 136 US locations, this retrospective study was designed to assess CLE efficiency compared to traditional device management, and examine its findings.
  
  
  METHODS
  All 7,044 US CLE transmissions from the ED and OR (January 2012-October 2014) were compared to 217 traditional requests where CIED interrogations/interpretations were performed by calling industry representatives to these sites.
  
  
  RESULTS
  CLE reduced the time to device interrogation/interpretation by 78%: 100 ± 140-22 ± 14 minutes, P < 0.0001, improving response time and consistency; ED: 82 ± 103-23 ± 18 minutes, P, ≤ 0.01; OR: 127 ± 181-17 ± 10 minutes, P < 0.0001. Actionable events (AE) (arrhythmia, device/lead abnormalities) were infrequent: 9.1% overall (ED: 9.9%; OR: 4.1%). Only 6.5% of patients with syncope/presyncope and 13.6% with a perceived shock had AE. AEs were more common in those with suspected device problems (30.4%) or audible alerts (52.6%). They were more likely in patients not enrolled in long-term remote monitoring (23.9% vs 8.2%, P < 0.0001) and in those with older CIED systems (7.4% in year 1 vs 31.0% after 10 years).
  
  
  CONCLUSIONS
  The many patients with CIEDs, and the ability to quickly identify the minority with high-risk AE from the no/low-risk majority, strongly support CLE use in the ED and OR, sites which are expensive and prioritize efficiency.
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Imdad
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Medtronic, plc, Mounds View, Minnesota.
authors.forename: Amisha S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Medtronic, plc, Mounds View, Minnesota.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Balgaard
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Lynda E
authors.initials: LE
authors.lastname: Rosenfeld
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D010865:Pilot Projects; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D013686:Telemetry / Q000295:instrumentation / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review
keywords: defibrillation - ICD; pacing