Current and future technologies for remote monitoring in cardiology and evidence from trial data.

All major manufacturers of implantable pacing or defibrillator technologies support remote monitoring of their devices. Integration of signals from several monitored variables can facilitate earlier detection of arrhythmia or technical problems, and can also identify patients at risk of deterioration. Meta-analyses of randomized studies of remote monitoring of heart failure using standalone systems suggest considerable clinical benefit when compared with usual care. However, there may be little to be gained by frequently monitoring patients with well-treated stable disease. Trials of implantable monitoring-only devices suggest that there is a subgroup of patients that may benefit from such remote monitoring. Remote monitoring is still not widely adopted due to a number of social, technological and reimbursement issues, but this is likely to change rapidly. Remote monitoring will not replace face-to-face clinical review, but it will be part of the solution to ever increasing numbers of patients with heart failure and/or an implantable device requiring expert input to their care.