Remote Monitoring Of Heart Devices: Keeping In Touch With The Care You Need

Millions of people who have had heart attacks or a degenerative disease called cardiomyopathy live longer lives because of pacemakers and implantable cardioverter defibrillator.

A pacemaker is a medical device that uses electrodes to send a slight electrical shock to regulate the beating of the heart. A biventricular pacemaker (BVP), also known as CRT (cardiac resynchronization therapy) is a type of pacemaker that stimulates the heart in two locations so that the two ventricles beat in synchrony. Modern pacemakers are externally programmable, enabling the cardiologist to select the most appropriate rhythm for the heart when health conditions change.

An implantable cardioverter defibrillator, also known as ICD, is a medical device that can deliver a shock to the heart in case of sudden death caused by ventricular tachyarrhythmias, extremely fast beats in the lower chambers of the heart. Some of the newer ICD's have leads that can be placed under the skin instead of through a vein into the heart. Nearly all ICD's now can be used to pace the heart during bradycardia, when the pulse is extremely slow.

An ICD is not a substitute for CPR if the heart stops; it is still necessary to do chest compressions in addition to the internal shock generated by the device.

This is usually unpleasant but is almost never fatal. About 1% of ICD's eventually malfunction because of problems with the leads. 

People can still die of cardiac arrest even if these devices are functioning perfectly, an ICD only delivering six shocks before it turns itself off, but 

Devices that Save Seriously Ailing Hearts

Anyone who receives any kind of pacemaker or ICD is seriously ill. Most protocols only authorize implantation of either of these devices in patients whose ejection fraction, a measurement of the amount of blood leaving the left ventricle with each beat compared to the amount coming in, of 35% or less. Other criteria also apply.

In heart patients for whom these devices are appropriate, however, one- and two-year death rates are usually cut in half compared to treatment with medication alone. A pacemaker can help a heart patient find more energy for daily activities, maybe not enough to get out and jog around the block (although some heart patients who have pacemakers can do this), but maybe enough to take care one's own dressing, bathing, and household chores or even enough to have sex. 

A Frequently Asked Question: What About ICDs and Sex?

ICD's are programmed to correct tachycardia, when the heart beats too fast. Sex makes the heart beat faster, and it's not impossible for an ICD to go off during sexual intercourse. When this happens, the person who has the implanted cardioverter device will usually feel a strong shock, but the partner usually only feels a tingling sensation. 

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Regular remote monitoring of the device, however, can extend life even longer and enable even greater physical activity. 

Benefits Of Remote Monitoring Of Pacemakers And ICD's

Traditionally, pacemaker and ICD patients see their doctors once every 3 to 6 months to assess their heart health and to make sure their devices are charged and working. At these clinic visits the doctor downloads data from the pacemaker or ICD that gives a good picture of changes in the heart and changes, if any, in the performance of the devices. Between office visits, however, the doctor does not have access to any data from the pacemaker or ICD. It is not possible to detect problems before they present symptoms, which for implanted cardiac device patients, may include death.

The website logs data about the device and about the heart and software notifies the doctor if there are potentially dangerous trends in either the function of the device or the function of the heart. It isn't necessary to call the doctor's office to do the data download. It's only necessary to have an implanted device capable of remote monitoring and an Internet connection.

The Lumos-T Safely Reduces Routine Office Device Follow-Up (TRUST) study recruited 908 recipients of implantable cardiac devices that had remote monitoring capability and 431 recipients of cardiac devices that did not for 1 to 4 years of follow-up. Average age of patients in both groups was 63 to 64 years. Ninety-seven, or about 7%, of the patients had already survived at least one cardiac arrest. Participants in the study were located all over the United States, and received care from 102 different medical centers.

The TRUST study found that remote monitoring was not a perfect system, but it holds significant advantages over conventional follow-up care:

• Without remote monitoring, problems with the heart or with the device may not be detected for six months. With remote monitoring, the doctor is notified within 24 hours. 
• With remote monitoring, patients with implanted devices were 45% less likely to need to be hospitalized and 100% less likely to need quarterly office visits just to check the device.

Adverse events, including heart attack, stroke, and death, were not significantly different between the two groups, even though the "sicker" patients were more likely to have been given a remotely monitored device.

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It's still necessary actually to go in and see the doctor to get changes in the settings of the device, a new prescription for antiarrhythmia drugs, or repairs to leads. You have to pick up the phone when your doctor's office calls. 

It's also important to understand that equipment-related problems are more likely the longer you have the device. You may not need to see the doctor as often when you have a remotely monitored cardiac device, but it becomes even more important to keep your appointments. Working with your doctor, however, this technology can improve your quality of life and your longevity. Ask about remote monitoring before you get a pacemaker or ICD or you have surgery to have them replaced.