Skip to main content
SpringerLink
Log in

Home Monitoring mit implantierbaren Defibrillatoren

—ein diagnostischer Fortschritt?

Home Monitoring with implantable ICD—a diagnostic innovation?

  • BEITRAG ZUM THEMENSCHWERPUNKT
  • Published:
Herzschrittmachertherapie & Elektrophysiologie Aims and scope Submit manuscript

Summary

In recent years the rate of ICD implantation has grown substantially after the results of primary and secondary prevention trails have shown significant improvement in mortality and morbidity. However, the increasing number of patients with ICD indication leaves the implanting centres with large logistic problems, esp. with the number of follow-up visits. To further ensure high quality standard in therapy management new follow up routines have to be considered. Possible help may come with new methods of telecardiology, which are presently being introduced into clinical practice. Those systems differ in the way that they are capable to substitute a routine follow up and/ or deliver continuous diagnostic and device status information. Maybe the most promising solution is Home Monitoring in which the implant sends automatically daily messages with regard to therapy and ICD/CRT status without any cooperation of the patient. Interaction of the physician can be triggered by patient individual event filter. By utilizing this features in combination with event related IEGM Online Data physician are able to guide patients more effectively.

Zusammenfassung

In den vergangenen Jahren haben die Ergebnisse großer Studien zur Primär- und Sekundärprävention zu einer deutlichen Erweiterung des Patientenkreises geführt, der nachweislich von der Implantation eines implantierbaren Defibrillators profitiert. Die dadurch anwachsende Zahl von Patienten stellt die implantierenden Zentren allerdings vor logistische Probleme, z. B. in der regelmäßigen Nachsorge. Um weiterhin den hohen Qualitätsstandard in der Versorgung dieser Patienten zu gewährleisten müssen neue Prozesse in der Therapienachsorge überdacht und eingeführt werden.

Eine mögliche Entlastung bieten neue telekardiologische Verfahren, die derzeit in der klinischen Einführung sind. Die Systeme unterscheiden sich in der Konzeption, eine Nachsorge zu substituieren bzw. kontinuierlich Informationen zu Therapie und Gerätestatus zu liefern. Das vielleicht Erfolg versprechendste System ist Home Monitoring, bei dem das Implantat ohne Zutun des Patienten automatisch täglich Nachrichten zu Therapie und ICD/CRT Status sendet. Die Interaktion zwischen Patienten und Arzt kann ortsunabhängig durch das Setzen von Ereignisfilter getriggert werden. Durch Nutzung dieser Funktion und der übertragenen ereignisbezogenen IEGM Online Daten ist es möglich den Patienten effizienter zu führen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Steinbeck G, Meinertz T, Andresen D, Borggrefe M, Brachmann J, Gonska BD, Klein H, Kuck KH, Manz M (1991) Empfehlungen zur Implantation von Defibrillatoren. Z Kardiol 80:475–478

    Google Scholar 

  2. Hohnloser SH, Andresen D, Block M Breithardt G, Jung W, Klein H, Kuck KH, Lüderitz B, Steinbeck G (2000) Leitlinien zur Implantation von Defibrillatoren. Z Kardiol 89:126–135

    Article  Google Scholar 

  3. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 335(26):1933–1940

    Article  PubMed  Google Scholar 

  4. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML, Multicenter Automatic Defibrillator Implantation Trial II Investigators (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346(12):877–883

    Article  PubMed  Google Scholar 

  5. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH (2005) Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352(3):225–237

    Article  PubMed  Google Scholar 

  6. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350(21):2140–2150

    Article  PubMed  Google Scholar 

  7. Cleland JG, Louis AA, Rigby AS, Janssens U, Balk AH, TEN-HMS Investigators (2005) Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 45(10):1654–1664

    Article  PubMed  Google Scholar 

  8. Curtis AB, Ellenbogen KA, Hammill SC, Hayes DL, Reynolds DW, Wilber DJ, Cain ME (2004) Clinical competency statement: Training pathways for implantation of cardioverter defibrillators and cardiac resynchronization devices. Heart Rhythm 1[3]:371–375

    Article  PubMed  Google Scholar 

  9. Ellenbogen KA, Wood MA, Shepard RK, Clemo HF, Vaughn T, Holloman K, Dow M, Leffler J, Abeyratne A, Verness D (2003) Detection and management of an implantable cardioverter defibrillator lead failure: incidence and clinical implications. J Am Coll Cardiol 41(1):73–80

    Article  PubMed  Google Scholar 

  10. Dorwarth U, Frey B, Dugas M, Matis T, Fiek M, Schmoeckel M, Remp T, Durchlaub I, Gerth A, Steinbeck G, Hoffmann E (2003) Transvenous defibrillation leads: high incidence of failure during long-term follow-up. J Cardiovasc Electrophysiol 14(1):38–43

    Article  PubMed  Google Scholar 

  11. Hauser RG, Kallinen L (2004) Deaths associated with implantable cardioverter defibrillator failure and deactivation reported in the United States Food and Drug Administration Manufacturer and User Facility Device Experience Database. Heart Rhythm 1(4):399–405

    Article  PubMed  Google Scholar 

  12. Senges-Becker JC, Klostermann M, Becker R, Bauer A, Siegler KE, Katus HA, Schoels W (2005) What is the “Optimal” follow-up schedule for ICD patients? Europace 7(4):319–326

    Article  PubMed  Google Scholar 

  13. Becker R, Ruf-Richter J, Senges-Becker JC, Bauer A, Weretka S, Voss F, Katus HA, Schoels W (2004) Patient alert in implantable cardioverter defibrillators: toy or tool? J Am Coll Cardiol 44(1):95–98

    Article  PubMed  Google Scholar 

  14. Nanthakumar K, Dorian P, Paquette M (2003) Is inappropriate implantable defibrillator shock therapy predictable? J Interv Card Electrophysiol 8(3):215–220

    Article  PubMed  Google Scholar 

  15. Theuns DA, Klootwijk AP, Simoons ML, Jordaens LJ (2005) Clinical variables predicting inappropriate use of implantable cardioverter-defibrillator in patients with coronary heart disease or nonischemic dilated cardiomyopathy. Am J Cardiol 95(2):271–274

    Article  PubMed  Google Scholar 

  16. Joseph GK, Wilkoff BL, Dresing T, Burkhardt J, Khaykin Y (2004) Remote interrogation and monitoring of implantable cardioverter defibrillators. J Interv Card Electrophysiol 11(2):161–166

    Article  PubMed  Google Scholar 

  17. Schoenfeld MH, Compton SJ, Mead RH, Weiss DN, Sherfesee L, Englund J, Mongeon LR (2004) Remote monitoring of implantable cardioverter defibrillators: a prospective analysis. Pacing Clin Electrophysiol 27(6 Pt 1):757–763

    Article  PubMed  Google Scholar 

  18. Wallbruck K, Stellbrink C, Santini M, Gill J, Hartmann A, Wunderlich E (2002) The value of permanent follow-up of implantable pacemakers—first results of an European trial. Biomed Tech [Berl] 47(Suppl 1 Pt 2):950–953

    Google Scholar 

  19. Scholten MF, Thornton AS, Theuns DA, Res J, Jordaens LJ (2004) Twiddler’s syndrome detected by home monitoring device. Pacing Clin Electrophysiol 27(8):1151–1152

    Article  PubMed  Google Scholar 

  20. Varma N, Stambler B, Chun S (2005) Detection of atrial fibrillation by implanted devices with wireless data transmission capability. Pacing Clin Elektrophysiol 28 (Suppl 1):S133–136

    Article  Google Scholar 

  21. Fonarow GC, Stevenson LW, Walden JA (1997) Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. J Am Coll Cardiol 30(3):725–732

    Article  PubMed  Google Scholar 

  22. Kasper EK, Gerstenblith G, Hefter G, Van Anden E, Brinker JA, Thiemann DR, Terrin M, Forman S, Gottlieb SH (2002) A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission. J Am Coll Cardiol 39(3):471–480

    Article  PubMed  Google Scholar 

  23. Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, Crombie P, Vaccarino V (2002) Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol 39(1):83–89

    Article  PubMed  Google Scholar 

  24. Lechat P, Hulot JS, Escolano S, Mallet A, Leizorovicz A, Werhlen-Grandjean M, Pochmalicki G, Dargie H (2001) Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II Trial. Circulation 103(10):1428–1433

    PubMed  Google Scholar 

  25. Opasich C, Rapezzi C, Lucci D, Gorini M, Pozzar F, Zanelli E, Tavazzi L, Maggioni AP, Italian Network on Congestive Heart Failure (IN-CHF) Investigators (2001) Precipitating factors and decision-making processes of short-term worsening heart failure despite “optimal” treatment (from the IN-CHF Registry). Am J Cardiol 88(4):382–387

    Article  PubMed  Google Scholar 

  26. Madsen BK, Rasmussen V, Hansen JF (1997) Predictors of sudden death and death from pump failure in congestive heart failure are different. Analysis of 24 h Holter monitoring, clinical variables, blood chemistry, exercise test and radionuclide angiography. Int J Cardiol 58(2):151–162

    Article  PubMed  Google Scholar 

  27. William T, Abraham MD (2003) Cardiac Resynchronization Therapy for the Management of Chronic Heart Failure. Am Heart Hosp J 1(1):55–61

    PubMed  Google Scholar 

  28. Stix G (2002) Home Monitoring technology for ICD therapy—first results from the European multicentre study. CardioStim, Nizza

  29. Neuser H, Schuchert A, Schmidinger H, Schumacher B (2004) Home Monitoring zur Individualisierung der ambulanten Nachsorge bei Patienten mit implantierbarem Kardioverter Defibrillator. In: Niederlag W, Lüderitz B, Hempel A, Lemke HU (Hrsg) Telekardiologie. Health Academy, Dresden, S 112–122

  30. Brugada P (2005) What evidence do we have to replace in-hospital ICD follow-up? Europace, Prag

  31. Neuser H, Dorszewski A, Schuchert A, Schumacher B, für die Home-ICD Studiengruppe (2004) Individualisierung der ICD-Therapie durch automatische Patientenfernüberwachung. Z Kardiol 93(Suppl 5):P359. 15. Jahrestagung der Arbeitsgruppe Herzschrittmacher und Arrhythmie der Deutschen Gesellschaft für Kardiologie—Herz- und Kreislaufforschung, Hamburg

    Google Scholar 

  32. Schirdewan A (2004) Verlängerte ICD-Nachsorgeintervalle durch den Einsatz von Home Monitoring. 15. Jahrestagung der Arbeitsgruppe Herzschrittmacher und Arrhythmie der Deutschen Gesellschaft für Kardiologie—Herz- und Kreislaufforschung, Hamburg

  33. Hindricks G (2004) Reduzierter Nachsorgeaufwand nach prophylaktischer ICD-Indikation unter Home Monitoring Überwachung. 70. Jahrestagung der Deutschen Gesellschaft für Kardiologie—Herz- und Kreislaufforschung, Mannheim

  34. Sack S (2004) Bedeutung von Home Monitoring in aktiven Implantaten für das Herzinsuffizienz Management. 15. Jahrestagung der Arbeitsgruppe Herzschrittmacher und Arrhythmie der Deutschen Gesellschaft für Kardiologie—Herz- und Kreislaufforschung, Hamburg

  35. Fauchier L, Sadoul N, Kouakam C, Briand, F, Chauvin M, Babuty D, Clementy J (2005) Potential cost savings by telemedicine-assisted long-term care of implantable cardioverter defibrillator recipients. Pacing Clin Elektrophysiol 28(Suppl 1):S225–259

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, 2103, 78050, Villingen-Schwenningen

    W. Jung &  R. Birkemeyer

Authors
  1. W. Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Birkemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Jung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jung, W., Birkemeyer, R. Home Monitoring mit implantierbaren Defibrillatoren. Herzschr. Elektrophys. 16, 183–190 (2005). https://doi.org/10.1007/s00399-005-0484-7

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00399-005-0484-7

Key words

Schlüsselwörter

Search

Navigation