Lunati Maurizio, Gasparini Maurizio, Santini Massimo, Landolina Maurizio, Perego Giovanni B, Pappone Carlo, Marzegalli Maurizio, Argiolas Carlo, Murthy Anant, Valsecchi Sergio
Niguarda Hospital, Milan, Italy.
Pacing Clin Electrophysiol. 2008 Jan;31(1):38-46. doi: 10.1111/j.1540-8159.2007.00923.x.
Launch of remote follow-up systems in Europe is currently underway. However, there is insufficient understanding of postimplant practices with respect to device follow-up, reprogramming of device features, and postshock clinic visits.
We analyzed device-stored data from patients implanted with biventricular defibrillators (CRT-ICD) to characterize the management of patients in current clinical practice and the potential impact of remote follow-up systems.
Two hundred and seventeen patients were identified, all with complete device-data for at least one year. Over a follow-up period of 570 +/- 158 days, 1,959 device interrogations were performed. Of these, the majority (1,280, 65%) involved the reprogramming of device parameters. The mean time interval between interrogations was 70 +/- 25 days. Overall, a marked reduction of interrogations requiring reprogramming was observed between the first six months of follow-up and subsequent periods (from 3.6 +/- 1.8 to 1.1 +/- 1.0 interrogations/six months). A mean of 6.0 +/- 5.9 device parameters was reprogrammed during the first six months of follow-up, versus 4.4 +/- 5.6 (P = 0.000) during the subsequent period. From multivariate analysis, a higher-than-median number of interrogations was found to be significantly associated with defibrillator shocks (OR:2.51; 95%CI:1.42-4.42). Following a shock, a total of 133 interrogations in 60 patients were performed with 80% of these occurring within five days of the shock, and 49% did not require device reprogramming.
Six months after implant, reprogramming of device parameters is significantly less frequent, making the use of remote follow-up systems a practical alternative for patients and physicians. Moreover, a considerable portion of post-shock interrogations does not involve reprogramming and may therefore be performed remotely.
欧洲目前正在推出远程随访系统。然而，对于植入设备后的随访、设备功能的重新编程以及电击后门诊就诊的实践了解不足。
我们分析了植入双心室除颤器（CRT-ICD）患者的设备存储数据，以描述当前临床实践中患者的管理情况以及远程随访系统的潜在影响。
共识别出217例患者，所有患者均有至少一年的完整设备数据。在570±158天的随访期内，进行了1959次设备问询。其中，大多数（1280次，65%）涉及设备参数的重新编程。问询之间的平均时间间隔为70±25天。总体而言，在随访的前六个月和后续期间，需要重新编程的问询次数显著减少（从3.6±1.8次/六个月降至1.1±1.0次/六个月）。随访的前六个月平均重新编程6.0±5.9个设备参数，而在后续期间为4.4±5.6个（P = 0.000）。多因素分析显示，高于中位数的问询次数与除颤器电击显著相关（OR：2.51；95%CI：1.42 - 4.42）。电击后，60例患者共进行了133次问询，其中80%在电击后五天内进行，49%不需要重新编程设备。
植入后六个月，设备参数的重新编程频率显著降低，这使得远程随访系统成为患者和医生的一种切实可行的选择。此外，相当一部分电击后的问询不涉及重新编程，因此可以远程进行。
