Theuns Dominic A M J, Rivero-Ayerza Maximo, Knops Paul, Res Jan C J, Jordaens Luc
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S63-5. doi: 10.1111/j.1540-8159.2008.02230.x.
Remote monitoring of implantable cardioverter defibrillators (ICD) is designed to decrease the number of ambulatory visits and facilitate the early detection of adverse events. We examined the impact of remote monitoring on clinical workload by a comprehensive analysis of transmitted events.
The study population consisted of 146 recipients of ICD capable of remote monitoring. Data were transmitted daily or in case of pre-specified events (e.g., arrhythmia, out-of-range lead and/or shock impedance). Transmitted events were classified as clinical (disease-related) or system-related. Event rates/patient/month were calculated and compared according to events classification and clinical groups.
During a mean follow-up of 22 +/- 16 months, a total of 57,148 remote transmissions were recorded. Of these transmissions, 1009 (1.8%) were triggered by a pre-specified event, including induced ventricular fibrillation (VF) episodes during defibrillation threshold testing. The median number of events/patient/month was 0.14. Event rates were similar in patients with primary and secondary prevention indications for ICD (0.15 vs. 0.11). After exclusion of the induced VF episodes, 5.6% of transmitted events were classified as system-related and 94.4% as clinical. The median number of clinical events/patient/month was 0.023. The clinical event-free rates were 62% and 45%, at 1 and 4 years, respectively.
Remote monitoring of ICD patients is feasible. Despite the large number of data transmissions, remote monitoring imposed a minimal additional burden on the clinical workload. The rate of triggered data transmissions by critical events was, relatively, very low.
植入式心脏复律除颤器（ICD）的远程监测旨在减少门诊就诊次数，并有助于早期发现不良事件。我们通过对传输事件的综合分析，研究了远程监测对临床工作量的影响。
研究人群包括146名具备远程监测功能的ICD接受者。数据每日传输，或在发生预先指定的事件（如心律失常、导联超出范围和/或电击阻抗）时传输。传输的事件分为临床（与疾病相关）或系统相关。根据事件分类和临床分组计算并比较事件发生率/患者/月。
在平均22±16个月的随访期间，共记录了57148次远程传输。在这些传输中，1009次（1.8%）由预先指定的事件触发，包括除颤阈值测试期间诱发的心室颤动（VF）发作。患者/月的事件中位数为0.14。ICD一级和二级预防指征患者的事件发生率相似（0.15对0.11）。排除诱发的VF发作后，5.6%的传输事件分类为系统相关，94.4%为临床相关。临床事件/患者/月的中位数为0.023。1年和4年时的临床无事件率分别为62%和45%。
ICD患者的远程监测是可行的。尽管数据传输量很大，但远程监测对临床工作量造成的额外负担极小。关键事件触发的数据传输率相对非常低。
