What is Remote Interrogation and Monitoring of Cardiovascular Implantable Electronic Devices?
Cardiovascular implantable electronic devices (CIEDs) are battery-powered electronic medical devices usually implanted in the chest area to treat a variety of cardiac arrhythmias.
An arrhythmia or irregular heartbeat is an abnormality in the rhythm or rate of your heartbeat. Your heart may be beating too fast (tachycardia) or too slowly (bradycardia). Arrhythmias can cause symptoms such as palpitations, lightheadedness, pounding heart, shortness of breath, sweating, and blurry vision.
Cardiovascular implantable electronic devices are used to monitor and control arrhythmias and restore normal heart rhythm/function. The 3 most common types of CIEDs in use are permanent pacemakers (PPMs), automated implantable cardioverter defibrillators (AICDs), and cardiac resynchronization therapy devices (CRTs).
Traditionally, patients with CIEDs have been followed with periodic clinic visits and have received direct interrogation by a programmer who checks the battery, lead impedance, sensing amplitude, pacing threshold, and arrhythmic events. Remote interrogation and monitoring of CIEDs is an innovative technique to perform the above screening remotely using an advanced transmitter placed in the patient’s bedroom or by using smartphone-based remote monitoring that transmits the patient’s data to the physician for assessment. Remote monitoring is utilized to supplement in-clinic follow-up for patients with cardiovascular implantable electronic devices every 6 to 12 months.
Indications for Remote Interrogation and Monitoring of Cardiovascular Implantable Electronic Devices
Remote interrogation and monitoring of CIEDs is indicated for patients with a cardiovascular implantable electronic device having difficulties in attending in-person follow-up visits or struggling with chronic device-related issues to expand the time between two in-person follow-up visits.
Remote interrogation and monitoring in patients with cardiovascular implantable cardiac devices is associated with a reduction of necessary healthcare resources, reduced hospitalization rates, and increased survival rates. Patients with CIEDs managed through remote interrogation and monitoring experience fewer inappropriate problems pertaining to CIEDs such as implantable cardioverter defibrillator (ICD) shocks, which is a significant aspect as ICD shocks are known to increase patient mortality. Therefore, remote interrogation and monitoring of CIEDs can minimize the occurrence of inappropriate shocks. Furthermore, remote monitoring can decrease the time between an event and a reaction with an associated reduction in adverse results due to technical issues or clinical problems. Moreover, remote monitoring reduces workload, is time-effective, as well as cost-effective. Most individuals have an unchanged or improved quality of life after device implantation and are satisfied with remote interrogation and monitoring.
How Does Remote Interrogation and Monitoring of Cardiovascular Implantable Electronic Devices Work?
Remote monitoring data are transmitted from CIEDs to a transmitter station either by wired or wireless communication. After the successful transmission of remote monitoring data, medical staff can check the data on a website from anywhere. The nature and volume of the transmitted data are almost the same as those of the data acquired from direct interrogation. Medical staff can get alert notifications by SMS, voice message, email, or fax. Sometimes, one can receive exact remote monitoring data immediately following an event such as inappropriate implantable cardioverter defibrillator (ICD) therapy, appropriate ICD therapy, and cardiovascular implantable electronic device abnormality. Medical staff can also automatically or manually activate message calls to patients to remind them of abnormalities.
How Does Remote Interrogation and Monitoring of Cardiovascular Implantable Electronic Devices Help With Patient Management?
Remote interrogation and monitoring of patients with a cardiovascular implantable electronic device basically includes 3 concepts:
- Remote follow-up with scheduled interrogations of the CIED
- Remote monitoring with unscheduled data transfers due to upcoming events or alerts
- Patient-initiated follow-ups with unscheduled data transfers due to symptomatic arrhythmias or other issues
These can help reduce the workload connected with CIED follow-up. Prior to remote interrogation and monitoring of CIEDs becoming available, patients with CIEDs had to visit a medical facility for periodic CIED checks. It is inconvenient for people living in rural areas to visit a medical facility for CIED interrogation. Visiting a medical facility is also inconvenient for individuals’ families because about half of the patients must be accompanied by family members, mainly the patients' children, who must take time off work to accompany the patients. It is also becoming troublesome to make appointments for CIED inspections because of the increasing number of patients with CIEDs caused by the aging society and expanded indications for CIED implantation. Individuals must spend several hours and occasionally even half a day in the medical facility to have their CIEDs evaluated.
However, the burden of visiting a medical facility is greatly reduced by utilizing remote interrogation and monitoring as it reduces the burden of overloaded clinics and saves valuable time and resources. Since using remote interrogation and monitoring, most individuals reported an improved or unchanged experience coping with their cardiac arrhythmia and felt better monitored, reassured, and/or secure. In addition, patients reported that remote monitoring resulted in a prolongation of intervals of in-person follow-up visits for device interrogation as well as in-person follow-up visits.