Europace Advance Access originally published online on April 22, 2008
Europace 2008 10(6):729-735; doi:10.1093/europace/eun099
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ICDs
Automatic home monitoring of implantable cardioverter defibrillators
1 Cardiology Department, Heart Center, University of Leipzig, Leipzig, Germany; 2 Department of Cardiology B, Skejby Hospital, Brendstrupgaardsvej, DK-8200 Aarhus N, Denmark; 3 Department of Cardiology and Pneumology, Heart Center, Goettingen, Germany; 4 CHU de Nancy Brabois, Vandoeuvre les Nancy, Nancy, France; 5 Cardiology Department, Carl-Thiem Clinic, Cottbus, Germany; 6 Clinic for Internal Medicine III, Department of Cardiology, Angiology and Pneumology, University Clinic Heidelberg, Germany; 7 Friedrich-Ebert-Hospital, Neumuenster, Germany; 8 Cardiology Department, Center of Cardiovascular Medicine, Bad Neustadt, Germany; 9 Cardiology Department, Medical University Vienna, Austria; 10 Service de Cardiologie E, Hopital Cardiologique du Haut-Leveque, Pessac, France; 11 Center for Clinical Research and Scientific Studies, Biotronik GmbH & Co. KG, Erlangen, Germany
Aims: With the expanding indications for implantable cardioverter defibrillator (ICD) and reports of unexpected ICD failures, home monitoring (HM) was proposed to decrease follow-up workload and increase patient safety. Home monitoring implantable cardioverter defibrillators offer wireless, everyday transfer of ICD status and therapy data to a central HM Service Center, which notifies the attending physician of relevant HM events. We evaluated functionality and safety of HM ICDs.
Methods and results: A total of 260 patients with HM ICDs were monitored for a mean of 10 ± 5 months. Time to HM events [medical (ventricular tachycardia/ventricular fibrillation) and technical (ICD system integrity)] since ICD implantation and since the latest in-clinic follow-up was analysed. Mean number of HM events per 100 patients per day was calculated, without and with a 2-day blanking period for re-notifying the same type of event. About 41.2% of the patients had HM events (38.1% medical, 0.8% technical, and 2.3% both types). Probability of any HM event after 1.5 years was 0.50 (95% confidence interval: 0.42–0.58). More than 60% of new HM event types occurred within the first month after follow-up. A mean of 0.86 event notifications was received per 100 patients per day or 0.45 with the 2-day blanking period.
Conclusion: Home monitoring is feasible and associated with an early detection of medical and technical events.
Key Words: Implantable cardioverter defibrillator, Fibrillation, Defibrillation, Tachycardia, Follow-up, Home monitoring
* Corresponding author. Tel: +45 89 49 55 66; fax: +45 89 49 60 02.E-mail address: cosedis{at}dadlnet.dk
Manuscript submitted 12 January 2008. Accepted after revision 24 March 2008.