부산대학교 도서관

Introduction: In the last years the remote monitoring of pacemakers and implantable cardioverter defibrillators (ICDs) has become an increasingly used method for an accurate surveillance of patientʼs clinical course and device efficiency. On the other hand, it generates a consistent set of incoming data, requiring considerable additional work to be analyzed. An accurate alert messages management, seems to be a crucial task for an easy and effective use of remote monitoring. The purpose of our study was to evaluate the different alerts setting and alert messages management in the electrophysiological centers of Veneto region, Italy.Methods: We prospectively evaluated 282 patients (181 males, 101 females, mean age 72±11 yrs), who were referred to 9 electrophysiological centers, for a pacemaker (76 patients) or ICD (206 patients) implant, in which remote monitoring was activated (Biotronik, Home Monitoring®).Results: During a mean follow-up of 382±261 days, we received 106,039 transmissions and 581 alerts messages (164 from pacemaker, 417 from ICDs; mean 2.06/yrs for pacemaker, mean 1.93/yr for ICD). In the pacemaker group, the alerts that were most frequently activated were those concerning battery exhaustion, surveying impedances, sensing and threshold measurements; the alerts most frequently received were those concerning high ventricular rate episodes, mode switch episodes, and reduction of sensed P wave amplitude. In the ICD group, the alerts nearly always activated were those concerning a detection setoff, battery exhaustion, critical values of impedance, or ineffective max energy shock; the alerts most frequently received were those concerning a reduced percentage of biventricular pacing, VF detection and atrial burden episodes.Conclusions: A limited number of alert messages was received. However, this was achieved by activating more frequently the alerts on critical issues related to the pacing system and restraining alerts on minor supraventricular and ventricular arrhythmias and on physiological parameters.These latter alerts may provide a more complete clinical profile of the patient, and are particularly useful in subjects with heart failure, but require an additional work for their analysis, that can only be reduced by a periodic review of the activation ranges.