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Understanding the efficacy of electronic cardiac implants

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Dr Dilip Kumar, Senior Interventional Cardiologist, Electrophysiologist and Chief Academic Coordinator, Medica Superspecialty Hospital, says that the utilisation of remote monitoring is rapidly expanding based on encouraging data from large clinical trials

‘Cardiac Implantable Electronic Devices’ sounds rather a mouthful, doesn’t it? So, what are these devices? In simple terms, these are devices that are implanted in a person with a heart condition to enable the heart to function normally. Pacemaker, ICD, CRT-P/D and Implantable Loop Recorder are such devices that may need to be implanted in people with different heart conditions that prevent the heart from functioning normally.

While these devices are often the only answer to a heart condition, they do come with a rider. You cannot go by the ‘fill it and forget it’ formula. It requires regular follow-up after implantation of a pacemaker (PM), implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy device (CRT) to assess the functionality of the device and adjust the parameters to optimise the device functions best suited to the patient as per the clinical requirement. The frequency of follow-up is determined by multiple factors, including co-morbidities like blood pressure, diabetes, kidney function, etc, geographic accessibility to medical care and type of the implanted device. 

Usually, people with such implants need periodic visits to the hospital/clinic for assessment by a programmer that checks the battery, lead impedance, sensing amplitude, pacing threshold and arrhythmic events. 

The importance of pacemaker follow-up was recognised soon after these devices were introduced around sixty years ago. Earlier, the leads (wires) and devices were not very reliable. After decades of technological innovation, the devices of recent generations are highly reliable and can store a tremendous amount of data, which is often very useful in making a clinical decision during any cardiac emergency.

However, the introduction of sophisticated devices, such as ICDs and CRTs, significantly increased the workload of a follow-up session due to the large amount of diagnostic data that now needs interpretation and device settings that have to be optimised. Even though most clinic follow-up visits are routine procedures that rarely require extensive changes to the settings.

The technology has continued to evolve and now the Remote Monitoring Device not only enables near-continuous monitoring of device status but can also provide clinically valuable diagnostic information from a patient’s home.

Secure online server

The Remote Monitoring Device constantly monitors the rhythm of the heart of a person with an implanted cardiac device from the comfort of home and transmits the reports to the doctor daily. Remote monitoring enables early diagnosis of technical or clinical issues, facilitating early clinical intervention if needed. This innovative technology has resulted in a significant reduction in the relative risk of death. Further, this device also helps in reducing hospitalisations, thus, lowering the overall cost borne by the patient. Remote monitoring allows doctors to detect issues early and build a care plan. Physicians may also receive notifications of clinically important events as recorded by the device over Email/Text or Phone Call. 

The way this works is simple. Device encrypted data is transmitted from the device to a bedside transmitter either by wired or wireless communication (depending on the device type). The transmitter is connected to a secure server through either broadband or cellular internet connection. The person with the implant has to plug in the transmitter before going to sleep and it will automatically monitor and conduct follow-ups on your device during the night or else as scheduled by a physician.

The utilisation of remote monitoring is rapidly expanding based on encouraging data from large clinical trials.

Consulting

Evolving health technology has recently seen the introduction of ICD and CRT devices that are Bluetooth enabled, thus, eliminating the need of bedside transmitter. These devices are paired via Bluetooth in a smartphone through a secured mobile application, which is connected to a secured server.

This wireless communication allows for continuous engagement, which may lead to earlier detection of clinically relevant events, thus, increasing the efficacy of remote monitoring. 

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