The modern EP practice: EHR and remote monitoring.

Cardiac implantable electronic devices (CIEDs) store clinically valuable, time-sensitive information regarding system integrity, arrhythmias, and heart failure parameters. Remote monitoring has impacted clinical practice by reducing scheduled office visits, providing protocols for device recalls and advisories, and facilitating the management of unscheduled encounters. The successful implementation of remote monitoring into clinical practice requires a new work flow and additional staff; the use of the electronic medical record to manage the data emanating from CIEDs poses an additional challenge. Solutions to these issues are discussed, and projections are made regarding the management of CIEDs in a modern electrophysiology practice.

[1]  R. Schweikert,et al.  Efficacy and Safety of Automatic Remote Monitoring for Implantable Cardioverter-Defibrillator Follow-Up: The Lumos-T Safely Reduces Routine Office Device Follow-Up (TRUST) Trial , 2010, Circulation.

[2]  S. Chun,et al.  Detection of Atrial Fibrillation by Implanted Devices with Wireless Data Transmission Capability , 2005, Pacing and clinical electrophysiology : PACE.

[3]  Joseph S Alpert,et al.  Recommendations from the Heart Rhythm Society Task Force on Device Performance Policies and Guidelines Endorsed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) and the International Coalition of Pacing and Electrophysiology Organizations (COPE). , 2006, Heart rhythm.

[4]  C. Gornick,et al.  Failure of impedance monitoring to prevent adverse clinical events caused by fracture of a recalled high-voltage implantable cardioverter-defibrillator lead. , 2008, Heart rhythm.

[5]  Renato Pietro Ricci,et al.  Telemedicine and cardiac implants: what is the benefit? , 2012, European heart journal.

[6]  R. Schweikert,et al.  Automatic Remote Monitoring of Implantable Cardioverter-Defibrillator Lead and Generator Performance: The Lumos-T Safely RedUceS RouTine Office Device Follow-Up (TRUST) Trial , 2010, Circulation. Arrhythmia and electrophysiology.

[7]  Sana M. Al-Khatib,et al.  Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: results from PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study. , 2010, Journal of the American College of Cardiology.

[8]  Maria Grazia Bongiorni,et al.  Practices of cardiac implantable electronic device follow-up: results of the European Heart Rhythm Association survey. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[9]  J. Alpert,et al.  Recommendations from the Heart Rhythm Society Task Force on Lead Performance Policies and Guidelines: developed in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). , 2009, Heart rhythm.

[10]  Philippe Mabo,et al.  A randomized trial of long-term remote monitoring of pacemaker recipients (The COMPAS trial) , 2011, European heart journal.

[11]  Niraj Varma,et al.  Rationale and design of a prospective study of the efficacy of a remote monitoring system used in implantable cardioverter defibrillator follow-up: the Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) study. , 2007, American heart journal.

[12]  A. Boyle,et al.  The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) trial: the value of wireless remote monitoring with automatic clinician alerts. , 2011, Journal of the American College of Cardiology.

[13]  W. Stevenson,et al.  Recalls and safety alerts involving pacemakers and implantable cardioverter-defibrillator generators. , 2001, JAMA.

[14]  G. Boriani,et al.  Device-detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators. , 2011, Journal of the American College of Cardiology.

[15]  N. Varma.  Automatic remote home monitoring of implantable cardioverter defibrillator lead and generator function: a system that tests itself everyday. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[16]  B. Wilkoff,et al.  Follow-up of patients with new cardiovascular implantable electronic devices: is adherence to the experts' recommendations associated with improved outcomes? , 2013, Heart rhythm.

[17]  B. Wilkoff,et al.  Device features for managing patients with heart failure. , 2011, Heart failure clinics.

[18]  Laura G. Qualls,et al.  Follow-up of Patients With New Cardiovascular Implantable Electronic Devices: Are Experts’ Recommendations Implemented in Routine Clinical Practice? , 2013, Circulation. Arrhythmia and electrophysiology.

[19]  Gillian D Sanders,et al.  Remote Monitoring of Implantable Cardioverter Defibrillators versus Quarterly Device Interrogations in Clinic: Results from a Randomized Pilot Clinical Trial , 2010, Journal of cardiovascular electrophysiology.

[20]  W. Stevenson,et al.  Changing Trends in Pacemaker and Implantable Cardioverter Defibrillator Generator Advisories , 2002, Pacing and clinical electrophysiology : PACE.

[21]  H. Burri.  Remote follow-up and continuous remote monitoring, distinguished. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[22]  J. Burkhardt,et al.  Remote Interrogation and Monitoring of Implantable Cardioverter Defibrillators , 2004, Journal of Interventional Cardiac Electrophysiology.

[23]  Hongyan Qiao,et al.  Clinical benefits of remote versus transtelephonic monitoring of implanted pacemakers. , 2009, Journal of the American College of Cardiology.

[24]  M. Santini,et al.  Home Monitoring in Patients with Implantable Cardiac Devices: Is There a Potential Reduction of Stroke Risk? Results from a Computer Model Tested Through Monte Carlo Simulations , 2009, Journal of cardiovascular electrophysiology.

[25]  Silvia G Priori,et al.  HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations: developed in partnership with the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA) , 2008, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[26]  Dominique Lacroix,et al.  A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial , 2012, European heart journal.

[27]  D. Weiss,et al.  Remote Monitoring of Implantable Cardioverter Defibrillators: , 2004, Pacing and clinical electrophysiology : PACE.

[28]  P. Brugada,et al.  Role of home monitoring in children with implantable cardioverter defibrillators for Brugada syndrome. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[29]  Renato Pietro Ricci,et al.  Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[30]  B. Stambler,et al.  Same-day discovery of implantable cardioverter defibrillator dysfunction in the TRUST remote monitoring trial: influence of contrasting messaging systems , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[31]  N. Varma.  Remote Monitoring for Advisories: Automatic Early Detection of Silent Lead Failure , 2009, Pacing and clinical electrophysiology : PACE.

[32]  H. Krumholz,et al.  Telemonitoring in patients with heart failure. , 2010, The New England journal of medicine.

[33]  S. A. Christman,et al.  Heart failure decompensation and all-cause mortality in relation to percent biventricular pacing in patients with heart failure: is a goal of 100% biventricular pacing necessary? , 2009, Journal of the American College of Cardiology.

[34]  P. Heidenreich,et al.  Long-Term Outcome After ICD and CRT Implantation and Influence of Remote Device Follow-Up: The ALTITUDE Survival Study , 2010, Circulation.

[35]  S. Mittal,et al.  Clinical Guidelines for Remote Monitoring , 2013 .

[36]  Niraj Varma,et al.  Remote monitoring of cardiovascular devices: a time and activity analysis. , 2012, Heart rhythm.