Schuchert A
Medizinische Klinik, Friedrich-Ebert-Krankenhaus, Friesenstr. 11, 24531 Neumünster.
Herzschrittmacherther Elektrophysiol. 2009 Dec;20(4):164-72. doi: 10.1007/s00399-009-0058-1.
Present-day remote systems for cardiovascular implantable electronic devices (CIEDs) provide, in contrast to previous solutions, a broad range of data about the patient and the implanted device ("remote control"). Telemedicine includes remote monitoring as well as remote follow-up: Remote monitoring is the continual interrogation of the device to detect patient- or device-related adverse events earlier than with standard follow-up visits. Remote follow-up aims to replace scheduled and unscheduled face-to-face follow-up visits due to the interrogation of the automatic pacemaker functions. Currently available remote systems, such as Home Monitoring, CareLink, Merlin.net, and Latitude, have in common that they interrogate the device, send these data to a server, and provide the data to the physician on a secured web site. Automatic wireless interrogation of the device is the preferred solution; however, the devices must have been equipped with a micro-antenna, which is usually restricted to more recent pacemaker models. Knowledge about remote control in pacemaker patients is limited, because most remote applications were evaluated in ICD and CRT patients. While the most frequently reported clinical event in pacemaker patients is atrial fibrillation, the impact in routine clinical follow-up still has to be evaluated in detail. Device-related adverse events are rare. Large, long-term, randomized trials are comparing remote and conventional approaches with the aim of demonstrating the benefits of telemedicine in this patient group.
与以往的解决方案相比，如今用于心血管植入式电子设备（CIED）的远程系统可提供大量有关患者及植入设备的数据（“远程控制”）。远程医疗包括远程监测和远程随访：远程监测是对设备进行持续询问，以便比标准随访就诊更早地检测出与患者或设备相关的不良事件。远程随访旨在通过对自动起搏器功能的询问来取代定期和不定期的面对面随访就诊。目前可用的远程系统，如家庭监测系统、CareLink、Merlin.net和Latitude，它们的共同之处在于对设备进行询问，将这些数据发送到服务器，并在安全的网站上向医生提供这些数据。对设备进行自动无线询问是首选解决方案；然而，设备必须配备微型天线，这通常仅限于较新的起搏器型号。起搏器患者对远程控制的了解有限，因为大多数远程应用是在植入式心律转复除颤器（ICD）和心脏再同步治疗（CRT）患者中进行评估的。虽然起搏器患者最常报告的临床事件是心房颤动，但在常规临床随访中的影响仍有待详细评估。与设备相关的不良事件很少见。大型、长期、随机试验正在比较远程和传统方法，目的是证明远程医疗在该患者群体中的益处。
