Telemetered Data

As the society is moving towards a much more ambulatory approach of patient care, the idea of remote monitoring is very attractive. When applied to ICD therapy, supervision of both clinical and technical aspects becomes possible [4, 5]. Table 3.2 gives an indication of the possibilities. Diagnostic data such as the numbers of aborted and delivered ICD therapies are an indicator

Paced Tele

Figure 3.17. Marker calibrations in ELA Medical defibrillators.

Paced Tele
Figure 3.18. Example of monitored diagnostic data in a cardiac resynchronization device. In July 2005, a decrease in thoracic impedance is paralleled by an increase in the fluid index (Medtronic).

Table 3.2. Stored clinical and technical information in the device, with a potential for remote monitoring.

Possibilities of diagnostic and therapeutic information with Home Monitoring with actual arrhythmia devices

Clinical Information General

- Electrogram in actual rhythm

- Heart rate

- Heart rate variability

Pacing related

- Percentage atrial pacing

- Percentage AV synchrony

- Percentage ventricular pacing

- Number of mode switches

Tachyarrhythmia related

- Number of AT episodes

- Number of AF episodes

- Number of VT episodes

- Number of VF episodes

- Number of nonsustained episodes

- Number of delivered ICD therapies

- Number of aborted ICD therapies

- Electrogram of arrhythmia

Sensor related

- Motion

- Respiration

- Impedance

- Pressure

Technical Information Battery status and voltage

Shock impedance P- and R-wave amplitudes Autocapture thresholds Impedance of pace/sense leads of the total incidence of tachyarrhythmias. Frequently recurring episodes of ventricular tachyarrhythmias in patients may indicate increasing instability and progression of cardiac disease.

Conclusion

In Chapter 6 we will present a series of examples of electrograms which were obtained with a variety of devices. In some cases, ancillary diagnostic data provided the information for the definite arrhythmia diagnosis. The more information that was present, the less necessary additional surface ECGs became.

References

1. Marchlinski FE, Buxton AE, Flores BF. The automatic implantable cardioverter defibrillator: Followup and complications. In: El-Sherif N, Samet P, editors. Cardiac pacing and electrophysiology. Orlando, Fl: Grune and Stratton, 1990, pp. 743-758.

2. Fantoni C, Raffa S, Regoli F, et al. Cardiac resynchronization therapy improves heart rate profile and heart rate variability of patients with moderate to severe heart failure. J Am Coll Cardiol 2005;46:1875-1882.

3. Yu CM, Wang L, Chau E, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 2005;112:841-848.

4. Theuns DA, Res JC, Jordaens LJ. Home monitoring in ICD therapy: future perspectives. Europace 2003;5:139-142.

5. Schoenfeld MH, Reynolds DW. Sophisticated remote implantable cardioverter-defibrillator follow-up: a status report. Pacing Clin Electrophysiol 2005;28:235-240.

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