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Device Interrogation (device + interrogation)
Selected AbstractsRemote Monitoring of Implantable Cardioverter Defibrillators versus Quarterly Device Interrogations in Clinic: Results from a Randomized Pilot Clinical TrialJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2010M.H.S., SANA M. AL-KHATIB M.D. ICD: Remote Monitoring Versus Clinic Interrogations.,Introduction: Remote monitoring is increasingly becoming the new standard of care for implantable cardioverter defibrillator (ICD) follow-up. We sought to determine whether remote monitoring of ICDs improves patient outcomes compared with quarterly device interrogations in clinic. Methods and Results: In this single-center pilot clinical trial, adult patients with an ICD were randomly assigned to remote monitoring versus quarterly device interrogations in clinic. The primary endpoint was a composite of cardiovascular hospitalization, emergency room visit for a cardiac cause, and unscheduled visit to the electrophysiology clinic for a device-related issue at 1 year. We also examined health-related quality of life, costs, and patient satisfaction with their ICD care. Of 151 patients enrolled in this trial, 76 were randomized to remote monitoring and 75 to quarterly device interrogations in clinic. There was no significant difference in the primary endpoint (32% in the remote monitoring arm vs 34% in the control arm; P = 0.8), mortality, or cost between the 2 arms. Quality of life and patient satisfaction were significantly better in the control arm than in the remote monitoring arm at 6 months (83 [25th, 75th percentiles 70, 90] vs 75 [50, 85]; P = 0.002 and 88 [75, 100] vs 75 [75, 88]; P = 0.03, respectively), but not at 12 months. Conclusion: We showed no significant reduction in cardiac-related resource utilization with remote monitoring of ICDs. However, given the small number of patients in our study, the real clinical and health economics impact of remote monitoring needs to be verified by a large, multicenter, randomized clinical trial. (J Cardiovasc Electrophysiol, Vol. 21, pp. 545-550, May 2010) [source] Successful Cervical MR Scan in a Patient Several Hours after Pacemaker ImplantationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2009DORITH GOLDSHER M.D. Recent data showed that patients with electrical implanted devices may under certain conditions be scanned safely by magnetic resonance imaging (MRI). The device must have been in place preferably for at least 4,8 weeks [Correction added after online publication 31-Aug-2009: number of weeks has been updated.] prior to MR imaging to allow healing and pacemaker pocket formation. We report on a patient with quadriplegia and suspected epidural hematoma referred for MR scan a day after he had a pacemaker implantation. The patient was also pacemaker-dependent. After considering the risk/benefit ratio in this patient, it was decided to perform the scan. The pacemaker was reprogrammed. MRI was performed under strict monitoring. A spinal cord contusion at the level of C1,3 was diagnosed. Based on the imaging findings no invasive procedure was done. Device interrogation found no change in sensing or pacing parameters or in the pacemaker's battery. At the end of the scan, the device was reprogrammed back to the initial settings. In this population, each scan should be discussed thoroughly and the risks to benefit ratio should be considered. Given appropriate precautions, in well-experienced imaging centers, MRI may be safely performed in patients with permanent cardiac electronic implantable devices. [source] Magnetic Resonance Imaging of Implantable Cardiac Rhythm Devices at 3.0 TeslaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2008J. ROD GIMBEL M.D. Background: A relaxation of the prohibition of scanning cardiac rhythm device patients is underway, largely because of the growing experience of safe scanning events at 1.5T. Magnetic resonance imaging (MRI) at 3T is becoming more common and may pose a different risk profile and outcome of MRI of cardiac device patients. Methods: No restrictions were placed on pacemaker dependency, region scanned, device type, or manufacturer. Sixteen scans at 3T were performed with an electrophysiologist present on 14 patients with a variety of devices from various manufacturers. An "MRI-S" strategy was used. Multimodal monitoring was required. Device interrogation was performed prior to, immediately after, and 1,3 months after the MRI. For nonpacemaker-dependent device patients, attempts were made to turn all device features off (with OOO programming the goal) conceptually rendering the device "invisible." In pacemaker-dependent patients, the device was programmed to asynchronous mode at highest output for the duration of the scan with the goal of rendering the device conceptually "invulnerable" to MRI effects. The specific absorption rate (SAR) was limited to 2W/kg. Results: All patients were successfully scanned. No arrhythmias were noted. No significant change in the programmed parameters, pacing thresholds, sensing, impedance, or battery parameters was noted. The insertable loop recorder (ILR) recorded prolonged artifactual asystole during MRI. One patient noted chest burning during the scan. Conclusions: Device patients may undergo carefully tailored 3T MRI scans when pre-MRI reprogramming of the device occurs in conjunction with extensive monitoring, supervision, and follow-up. [source] Feasibility of Magnetic Resonance Imaging in Patients with an Implantable Loop RecorderPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2008JORGE A. WONG M.D. Background: The implantable loop recorder (ILR) is a useful tool in the diagnosis of syncope. Our understanding of their functional and safety profile in interfering environments such as magnetic resonance imaging (MRI) becomes increasingly important as they become more prevalent. Methods: We report four patients with an ILR who underwent MRI. The ILR memory was cleared before MRI and no changes were made to programmed settings. Device interrogation took place immediately after the scan. Patients were surveyed for device movement and heating, in addition to cardiopulmonary symptoms after their MRI. Results: Following MRI scanning, all patients were asymptomatic and no device movement or heating was observed. In addition, the functionality of the device remained unaffected. Artifacts mimicking arrhythmias were seen in all ILR patients regardless of the type of MRI scan. Conclusions: MRI scanning of ILR patients can be performed without harm to patient or device, but artifacts that could be mistaken for a tachyarrhythmia are seen frequently. [source] Pseudo Crosstalk Behavior in a Patient with Atrio-ventricular Block and Implanted Biventricular DefibrillatorPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2007REGINALD T. HO M.D. We present a 59-year-old man with a dilated cardiomyopathy (ejection fraction = 20%), congestive heart failure and atrio-ventricular (AV) block who underwent implantation of a biventricular defibrillator (BiV ICD). While undergoing cardiac transplant evaluation for drug-refractory ventricular fibrillation, his telemetry recorded findings resembling crosstalk inhibition. Device interrogation was normal. All episodes occurred at 1:00 a.m. suggesting a routine device operation. Left ventricular capture management, a new feature that automatically measures left ventricular pacing thresholds at 1:00 a.m., had been programmed to Monitor. Understanding this sophisticated pacing algorithm might avoid confusion when operative in patients with AV block. [source] Performance of an Autonomous Telemonitoring System in Children and Young Adults with Congenital Heart DiseasesPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2008PETER ZARTNER M.D. Background:Integrated telemonitoring systems controlling circulatory and electrical parameters in adults with an implanted pacemaker have shown to be advantageous during follow-up of this patient group. In children and young adults with a congenital heart disease (CHD), these systems have to cope with a diversity of varying arrhythmias and a broad range of intrinsic cardiac parameters. Additional problems arise from the patients' growth and anatomic anomalies. Methods:Since 2005, eight young patients (age 4.1, 37 years, mean 15.5 years) with a CHD received a pacemaker or implantable cardioverter defibrillator with an autonomous telemonitoring system at our clinic. The mean follow-up time was 395 days (range 106,834 days, 8.7 patient years). Results:In seven of eight patients the system transmitted information, which led to beneficial modifications of the current antiarrhythmic therapy. In three patients the reported events were of a critical nature. One patient remained event-free for 192 days after implantation. During follow-up, 96% of the days were covered. The system also transferred additional information on the effectiveness of antiarrhythmic medication and the impact of physical activity. Conclusions:Young patients with an insufficient intrinsic heart rate or progressing arrhythmia, in addition to the conventional indications for pacemaker or defibrillator implantation, seem to profit to a high percentage from a telemetric surveillance system. The fully automated procedure of device interrogation and information transmission gives a daily overview on system function and specific arrhythmic events, especially in children who are unaware of any symptoms. [source] Remote Monitoring of Implantable Cardioverter Defibrillators versus Quarterly Device Interrogations in Clinic: Results from a Randomized Pilot Clinical TrialJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2010M.H.S., SANA M. AL-KHATIB M.D. ICD: Remote Monitoring Versus Clinic Interrogations.,Introduction: Remote monitoring is increasingly becoming the new standard of care for implantable cardioverter defibrillator (ICD) follow-up. We sought to determine whether remote monitoring of ICDs improves patient outcomes compared with quarterly device interrogations in clinic. Methods and Results: In this single-center pilot clinical trial, adult patients with an ICD were randomly assigned to remote monitoring versus quarterly device interrogations in clinic. The primary endpoint was a composite of cardiovascular hospitalization, emergency room visit for a cardiac cause, and unscheduled visit to the electrophysiology clinic for a device-related issue at 1 year. We also examined health-related quality of life, costs, and patient satisfaction with their ICD care. Of 151 patients enrolled in this trial, 76 were randomized to remote monitoring and 75 to quarterly device interrogations in clinic. There was no significant difference in the primary endpoint (32% in the remote monitoring arm vs 34% in the control arm; P = 0.8), mortality, or cost between the 2 arms. Quality of life and patient satisfaction were significantly better in the control arm than in the remote monitoring arm at 6 months (83 [25th, 75th percentiles 70, 90] vs 75 [50, 85]; P = 0.002 and 88 [75, 100] vs 75 [75, 88]; P = 0.03, respectively), but not at 12 months. Conclusion: We showed no significant reduction in cardiac-related resource utilization with remote monitoring of ICDs. However, given the small number of patients in our study, the real clinical and health economics impact of remote monitoring needs to be verified by a large, multicenter, randomized clinical trial. (J Cardiovasc Electrophysiol, Vol. 21, pp. 545-550, May 2010) [source] Electrocardiographic Findings, Device Therapies, and Comorbidities in Octogenarian Implantable Defibrillator RecipientsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2010JAMES D. DANIELS M.D. Implantable Defibrillators in Octogenarians.,Background: The use of implantable cardioverter-defibrillators (ICDs) in octogenarians is poorly defined. Objective: To assess baseline electrocardiographic (ECG) findings, arrhythmia episodes, and development of severe nonarrhythmic illness or death in patients aged ,80 years at ICD implantation, and to compare them with younger patients. Methods: Medical records and device interrogations for 199 patients ,70 years old who underwent ICD implantation were reviewed. Patients were divided into 3 groups based on age at the time of implant: age 70,74 (group 1; 88 patients), age 75,79 (group 2; 67 patients), and age ,80 (group 3; 44 patients). Results: ECGs: Octogenarians were more likely to have sinus bradycardia (SB) (P = 0.047) and left bundle branch block (LBBB) (P = 0.043) compared to younger patients. There was no difference among groups in the proportion of patients with atrial fibrillation or any degree of AV block. Therapies: There was no difference between age groups in any therapy (P = 0.78), appropriate therapy (P = 0.54), or inappropriate therapy (P = 0.21) per patient-year. There was no difference between groups in time-to-first therapy of any type (P = 0.71). Nonarrhythmic death/morbidity: There was no difference between groups in time to death or serious illness. Conclusion: Our study is the first to evaluate in detail the therapies received by octogenarians after ICD placement. The higher incidence of SB and LBBB might influence the number of pacing sites in octogenarian patients. Very elderly patients have similar rates of arrhythmic episodes and development of severe comorbidities as septuagenarians, and they should not be denied ICD implantation based solely on age. (J Cardiovasc Electrophysiol, Vol. 21, pp. 236,241, March 2010) [source] Remote, Wireless, Ambulatory Monitoring of Implantable Pacemakers, Cardioverter Defibrillators, and Cardiac Resynchronization Therapy Systems: Analysis of a Worldwide DatabasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2007ARNAUD LAZARUS M.D. Study Objective: To describe the daily routine application of a new telemonitoring system in a large population of cardiac device recipients. Methods: Data transmitted daily and automatically by a remote, wireless Home MonitoringÔ system (HM) were analyzed. The average time gained in the detection of events using HM versus standard practice and the impact of HM on physician workload were examined. The mean interval between device interrogations was used to compare the rates of follow-up visits versus that recommended in guidelines. Results: 3,004,763 transmissions were made by 11,624 recipients of pacemakers (n = 4,631), defibrillators (ICD; n = 6,548), and combined ICD + cardiac resynchronization therapy (CRT-D) systems (n = 445) worldwide. The duration of monitoring/patient ranged from 1 to 49 months, representing 10,057 years. The vast majority (86%) of events were disease-related. The mean interval between last follow-up and occurrence of events notified by HM was 26 days, representing a putative temporal gain of 154 and 64 days in patients usually followed at 6- and 3-month intervals, respectively. The mean numbers of events per patient per month reported to the caregivers for the overall population was 0.6. On average, 47.6% of the patients were event-free. The mean interval between follow-up visits in patients with pacemakers, single-chamber ICDs, dual chamber ICDs, and CRT-D systems were 5.9 ± 2.1, 3.6 ± 3.3, 3.3 ± 3.5, and 1.9 ± 2.9 months, respectively. Conclusions: This broad clinical application of a new monitoring system strongly supports its capability to improve the care of cardiac device recipients, enhance their safety, and optimize the allocation of health resources. [source] | ||||||||||