Crossley George H, Chen Jane, Choucair Wassim, Cohen Todd J, Gohn Douglas C, Johnson W Ben, Kennedy Eleanor E, Mongeon Luc R, Serwer Gerald A, Qiao Hongyan, Wilkoff Bruce L
St. Thomas Research Institute and University of Tennessee College of Medicine, Nashville, Tennessee 37203, USA.
J Am Coll Cardiol. 2009 Nov 24;54(22):2012-9. doi: 10.1016/j.jacc.2009.10.001.
The purpose of this study was to evaluate remote pacemaker interrogation for the earlier diagnosis of clinically actionable events compared with traditional transtelephonic monitoring and routine in-person evaluation.
Pacemaker patient follow-up procedures have evolved from evaluating devices with little programmability and diagnostic information solely in person to transtelephonic rhythm strip recordings that allow monitoring of basic device function. More recently developed remote monitoring technology leverages expanded device capabilities, augmenting traditional transtelephonic monitoring to evaluate patients via full device interrogation.
The time to first diagnosis of a clinically actionable event was compared in patients who were followed by remote interrogation (Remote) and those who were followed per standard of care with office visits augmented by transtelephonic monitoring (Control). Patients were randomized 2:1. Remote arm patients transmitted pacemaker information at 3-month intervals. Control arm patients with a single-chamber pacemaker transmitted at 2-month intervals. Control arm patients with dual-chamber devices transmitted at 2-month intervals with an office visit at 6 months. All patients were seen in office at 12 months.
The mean time to first diagnosis of clinically actionable events was earlier in the Remote arm (5.7 months) than in the Control arm (7.7 months). Three (2%) of the 190 events in the Control arm and 446 (66%) of 676 events in the Remote arm were identified remotely.
The strategic use of remote pacemaker interrogation follow-up detects actionable events that are potentially important more quickly and more frequently than transtelephonic rhythm strip recordings. The use of transtelephonic rhythm strips for pacemaker follow-up is of little value except for battery status determinations. (PREFER [Pacemaker Remote Follow-up Evaluation and Review]; NCT00294645).
本研究旨在评估与传统电话监测及常规门诊评估相比，远程起搏器问询在临床可采取行动事件早期诊断中的作用。
起搏器患者随访程序已从仅面对面评估可编程性和诊断信息有限的设备，发展到通过电话传输心律记录来监测基本设备功能。最近开发的远程监测技术利用了扩展的设备功能，在传统电话监测的基础上，通过对设备进行全面问询来评估患者。
比较接受远程问询（远程组）和按照标准护理流程（对照组）进行随访的患者首次诊断临床可采取行动事件的时间。对照组通过电话监测辅助门诊就诊。患者按2:1随机分组。远程组患者每3个月传输一次起搏器信息。单腔起搏器的对照组患者每2个月传输一次信息。双腔起搏器的对照组患者每2个月传输一次信息，并在6个月时进行门诊就诊。所有患者在12个月时进行门诊检查。
远程组首次诊断临床可采取行动事件的平均时间（5.7个月）早于对照组（7.7个月）。对照组190例事件中有3例（2%）通过远程识别，远程组676例事件中有446例（66%）通过远程识别。
与电话传输心律记录相比，战略性地使用远程起搏器问询随访能更快、更频繁地检测到可能具有重要意义的可采取行动事件。除了确定电池状态外，使用电话传输心律记录进行起搏器随访价值不大。（PREFER[起搏器远程随访评估与审查]；NCT00294645）
