title: [Safety and efficacy of classic ambulatory implantable cardioverter-defibrillator and resynchronisation systems follow-up compared to telemetric follow-up].
abstract: Telemetric follow-up (RM) after cardiac devices implantation is not only not inferior to classic follow-up, but also enables earlier clinical complications detection and stricter patient monitoring.
  
  
  OBJECTIVE
  of the study was to confirm safety and efficacy of RM in patients with implantable cardioverter-defibrillator (ICD) or cardioverterdefibrillator with resynchronisation therapy (CRT-D), compared to traditional follow-up in outpatient clinic.
  
  
  METHODS
  Group A (CRT-D+ICD) (retrospective, patients followed-up in outpatient clinic) was consisted with 273 patients (mean age 65±11 years, 230M). Group A included 128 patients after CRT-D implantation and 145 patients with ICD. Group B (RM group) (prospective, RM Medtronic CareLink follow-up) involved 89 patients (mean age 61±14 years, 73M). 11 patients had CRT-D and 78 had ICD implanted. Only patients with Medtronic equipment were included to group B. Follow-up of patients from group A - ambulatory visit in outpatient clinic: 1-3 months after implantation, then every 6 months. Follow-up of patients from group B - daily follow-up using RM system (Medtronic CareLink). Patient's clinical status, medications, frequency/ type of arrhythmias, device interventions were assessed in both groups.
  
  
  RESULTS
  To assess presence of ventricular arrhythmia, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, a number of patients were randomly chosen from group A. They were similar in age, gender, LVEF value, NYHA class, comorbidities, time of follow-up (control group) to Group B (RM group). In the RM group, compared to control group, there were significantly less programming changes (3,4 vs 28,6%, p<0,001), time to first event was shorter (ventricular arrhythmia - 39 days, p<0,001; intervention - 102 days, p<0,001), time to first necessary programming change was longer (201 days, p<0,001). RM system proved to be save, more accurate (22% visits were performed personally by the physician operating Medtronic CareLink system, 71,4% consultations were performed via internet, phone), and general mortality did not differ significantly between the groups (p=0,147).
  
  
  CONCLUSIONS
  Telemetric follow-up of cardiac implantable devices is a safe and more accurate method in comparison to classic ambulatory follow-up. Telemetric follow-up of cardiac implantable devices enables quick information transmission in case of clinical complications (arrhythmia, intervention). Telemetric follow-up allows to reduce number of ambulatory visits to only necessary ones.
authors.affiliation: Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Jacek
authors.initials: J
authors.lastname: Lelakowski
authors.affiliation: Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Anna
authors.initials: A
authors.lastname: Rydlewska
authors.affiliation: Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Justyna
authors.initials: J
authors.lastname: Piekarz
authors.affiliation: The John Paul II Hospital in Kraków.
authors.forename: Maria
authors.initials: M
authors.lastname: Lelakowska-Pieła
authors.affiliation: Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Joanna
authors.initials: J
authors.lastname: Pudło
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D013686:Telemetry; D016896:Treatment Outcome; D055815:Young Adult
keywords: CRTD; ICD; Telemetric follow-up; traditional follow-up in outpatient clinic