Kloosterman Esteban M, Rosenbaum Murray, La Starza Brian, Wilcox Jamil, Rosman Jonathan
Boca Raton Regional Hospital, Boca Raton, FL, USA.
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
J Innov Card Rhythm Manag. 2019 Jan 15;10(1):3477-3484. doi: 10.19102/icrm.2019.100102. eCollection 2019 Jan.
The purpose of the present study was to evaluate the performance of remote-control (RC) management of cardiac implantable electronic devices (CIEDs) in clinical practice using a new service model in patients undergoing magnetic resonance imaging (MRI) scans. The number of CIEDs is constantly growing, alongside the demands for prompt checks. Although remote CIED interrogation exists, ultimately, real-time remote management is the goal. In this study, patients with MRI-conditional devices suitable for RC interaction who required an MRI were enrolled. An onsite technician began the RC session by contacting the remote operator, applying the programmer wand, and keying in an access code. The device was remotely checked via encrypted Wi-Fi by an electrophysiologist using a laptop. An MRI-safe mode was programmed per a preestablished proprietary algorithm. Following the scan, patient devices were remotely reinterrogated and reprogrammed to baseline, with adjustments made as clinically necessary. Patients subsequently were asked to complete a survey. Ultimately, a total of 100 RC CIED reprogrammings were performed in 50 MRI sessions, prescan and postscan. The average RC time interaction was four minutes prescan and three minutes postscan, respectively. No complications occurred. Five patients had more than one MRI in this study and 15 patients had had previous MRIs. In eight patients, baseline settings were reprogrammed. Most patients (82%) were very satisfied, preferring device specialist remote management. Only 14 (32%) patients used home remote monitoring. In conclusion, RC management of CIEDs in the MRI setting is feasible, safe, and clinically relevant. Use of the MRI mode determination algorithm was safe, consistent, and efficient. Expanding RC in CIED management for service anytime, anywhere is the next challenge.
本研究的目的是在接受磁共振成像（MRI）扫描的患者中，使用一种新的服务模式评估心脏植入式电子设备（CIED）远程控制（RC）管理在临床实践中的表现。CIED的数量在不断增加，同时对快速检查的需求也在增加。尽管存在CIED远程询问，但最终实时远程管理才是目标。在本研究中，纳入了需要进行MRI且其设备适合RC交互的患者。一名现场技术人员通过联系远程操作员、应用编程棒并输入访问代码来开始RC会话。一名电生理学家使用笔记本电脑通过加密的Wi-Fi对设备进行远程检查。根据预先建立的专有算法对MRI安全模式进行编程。扫描后，对患者的设备进行远程重新询问并重新编程至基线状态，并根据临床需要进行调整。随后要求患者完成一项调查。最终，在50次MRI检查中，共进行了100次RC CIED重新编程，包括扫描前和扫描后。平均RC交互时间分别为扫描前4分钟和扫描后3分钟。未发生并发症。在本研究中，5名患者接受了不止一次MRI检查，15名患者曾接受过MRI检查。8名患者的基线设置被重新编程。大多数患者（82%）非常满意，更喜欢设备专家的远程管理。只有14名（32%）患者使用家庭远程监测。总之，在MRI环境中对CIED进行RC管理是可行、安全且与临床相关的。MRI模式确定算法的使用是安全、一致且高效的。在CIED管理中随时随地扩展RC服务是下一个挑战。
