| Background:With the increasing prevalence of cardiovascular disease,advances of medical technology and equipment,and the expansion of implantation indications,the number of implanted cardiac implantable electronic devices(CIEDs)was increasing year by year.Implantation is only the beginning of the treatment,follow-up after operation is also an important part of the whole treatment system.The traditional in-office follow-up requires not only the hospital has the corresponding technology and equipment,but also need the patients’ arrival,which increases the burden of patients and Outpatient Department to a great extent.Therefore,in 1970s,CIEDs with the function of remote monitoring came into being,a large number of foreign studies have confirmed that the remote monitoring can be early detection and recognition of arrhythmia events and equipment failure,and through appropriate early intervention to improve the prognosis of patients and their safety and reduce in-office visits.In 2015,the American Heart Rhythm Society(HRS)recommended RM as a IA indication for the standard follow-up strategy for patients with CIED in the expert consensus of remote monitoring.However,the application of CIEDs with remote monitoring function is relatively low and the domestic research is few in our country.Objective:this paper aims at through the observation and analysis of the information transmitted by the remote monitoring system with CIEDs,and then understand the clinical application of remote monitoring function in the follow-up of patients with CIEDs.Methods:Patients were selected from January 1,2011 to January 31,2017 in our hospital who were implanted the Cardiac implantable electronic devices with remote monitoring function,including permanent pacemaker(PM),implantable cardioverter defibrillator(ICD)and with or without defibrillation function of cardiac resynchronization therapy(CRT-P/D).pacemaker manufacturers including Medtronic,biotronik,and St.Jude,all open the remote monitoring system after operation,and transmit the information through respective remote follow-up systems,the means of transmission including scheduled,triggered by events or manually transmited by patients,finally delivered the information to the corresponding remote monitoring system through the web site,we collect and analyze the relevant transmitted information.We analyze the information through whether there are any clinical events,the type of the event,and whether the program is transmitted according to the plan.Clinical events are divided into two categories:the relevant events of cardiovascular disease(arrhythmias,low patient activity,fluid retention,abnormal ventricular pacing ratio,the average heart rate exceeds the upper limit,HRV abnormal events)and system related events(sudden abnormal of the impedance,threshold and perception of the lead,or pacemaker battery energy depletion etc.).Results:1.From January 1,2011 to January 31,2017,the total of patients implanted with CIEDs in our hospital are 1995 cases,28(1.4%)implanted CIEDs with remote monitoring function,Among them,16 cases were implanted with permanent pacemaker(including dual chamber and single chamber PPM):4 cases of sick sinus syndrome,8 cases of atrioventricular block,slow ventricular rate in 2 patients with persistent atrial fibrillation,persistent atrial fibrillation with long R-R interval in 2 cases;A total of 9 patients with ICD were enrolled:8 cases of ventricular tachycardia,1 cases of dilated cardiomyopathy with syncope;3 cases were implanted with CRT-D,all because of heart failure with ventricular tachycardia.The mean age at implantation was 69±13(56-82)years old,of which there were 17 cases of male.2.Of the 28 patients,one had no transmission of information after implantation,the remaining 27 patients had the information transmitted to the corresponding sites,and only 6 cases(21%)were transferred according to the plan,6 cases(21%)had manual transmission.3.Remote monitoring system transmits information 5037 times,about 93.2%of the transmission information is not abnormal,the event information for a total of 341 times,accounting for about 6.8%of the total,about 73.2%of the event information required for intervention and treatment.4.Event information types:the relevant events of cardiovascular disease:the most common events are supraventricular arrhythmia(51.6%),which accounted for 46.3%of atrial fibrillation;ventricular arrhythmia(ventricular tachycardia,ventricular fibrillation,ventricular premature abnormal load etc.)accounted for 17.6%of the event information.The abnormal parameters of heart failure(14.4%),such as low patient activity,fluid retention,ventricular pacing ratio,and so on.System related events(about 16.4%):Electrode sensing and sensing sensitivity range of safety,ventricular automatic capture pacing in high output mode mode,etc.5.There were 5 patients who had no history of atrial fibrillation and atrial flutter,from the remote monitoring system,atrial fibrillation and atrial flutter were founded.6.There were 3 patients transmit information with atrial arrhythmia frequently,finally confirmed of atrial fibrillation trough Intracavitary electrocardiogram,of which one had no history of atrial fibrillation,and the others had a history of paroxysmal atrial fibrillation.The patients were told to adjust the use of drugs in clinic.Conclusion:1.At present,low CIEDs implantation with remote monitoring function.2.The compliance of patients with CIEDs with remote monitoring is low.3.Remote monitoring can detect and identify arrhythmia and equipment failure early,so that clinicians and related technical personnel can find out the problems in time,so as to carry out early intervention and treatment of the related events.4.The remote monitoring of CIEDs is safe and feasible,and may gradually replace the traditional in-office follow-up. |
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