Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
Europace. 2013 Jul;15(7):978-83. doi: 10.1093/europace/eut002. Epub 2013 Feb 17.
Remote follow-up (FU) enables to cope with the expanding number of pacemaker (PM) FU. Although remote FU offers comparable monitoring options to in-office FU, reprogramming of device settings is not available, thereby imposing a potentially important restriction to the applicability of remote FU. The aim of this study was to assess in a large cohort of bradycardia PM recipients, the incidence of PM reprogramming during long-term FU and its predictors, to judge the possibilities for remote FU.
Between 2003 and 2010 all in-office FU of 1517 bradycardia PM recipients included in the FOLLOWPACE study were recorded. Only 24.5% of all 13 258 recorded FU visits >3 months after implantation were visits-with-reprogramming (VWRs), occurring in 1158 patients (79%). Fifty percent of patients were free of reprogramming at 9 months, and 29% at 24 months. Using multivariable binary logistic regression analysis, the following patient characteristics were predictive for frequent PM reprogramming, defined as >3 VWRs during 3 year FU: age, a history of atrial arrhythmias, PM complication <3 months after implantation, congestive heart failure, PM indication, and lead fixation method. This model had a receiver operating characteristic area of 0.66 (95% confidence interval 0.61-0.71).
This study observed a low proportion of VWR (∼25%) during a mean FU of 5.3 years; however, those patients at high risk for PM reprogramming cannot easily be predicted. The vast majority of patients (>80%) do not need frequent reprogramming, suggesting a potential benefit of using remote FU to reduce the number of unnecessary in-office visits.
远程随访（FU）可用于应对不断增加的起搏器（PM）FU 数量。尽管远程 FU 提供了与门诊 FU 相当的监测选项，但无法进行设备设置的重新编程，这对远程 FU 的适用性构成了潜在的重要限制。本研究的目的是在大量心动过缓 PM 接受者中评估长期 FU 期间 PM 重新编程的发生率及其预测因素，以判断远程 FU 的可能性。
在 2003 年至 2010 年间，记录了纳入 FOLLOWPACE 研究的 1517 例心动过缓 PM 接受者的所有门诊 FU。在植入后 3 个月以上的所有 13258 次记录的 FU 就诊中，只有 24.5%（1158 例患者）为就诊带重新编程（VWR）。50%的患者在 9 个月时无需重新编程，29%的患者在 24 个月时无需重新编程。使用多变量二项逻辑回归分析，以下患者特征可预测频繁的 PM 重新编程，即在 3 年 FU 期间进行>3 次 VWR：年龄、心房心律失常史、植入后 3 个月内的 PM 并发症、充血性心力衰竭、PM 适应证和导联固定方法。该模型的受试者工作特征曲线下面积为 0.66（95%置信区间 0.61-0.71）。
本研究观察到在平均 FU 5.3 年内 VWR 的比例较低（约 25%）；然而，那些有 PM 重新编程高风险的患者不能轻易预测。绝大多数患者（>80%）不需要频繁重新编程，这表明使用远程 FU 来减少不必要的门诊就诊次数可能具有潜在益处。
