QUARTERLY FOCUS ISSUE: HEART RHYTHM DISORDERS: CLINICAL RESEARCH
Clinical Benefits of Remote Versus Transtelephonic Monitoring of Implanted Pacemakers
George H. Crossley, MD*,*,
Jane Chen, MD ,
Wassim Choucair, MD ,
Todd J. Cohen, MD ,
Douglas C. Gohn, MD||,
W. Ben Johnson, MD¶,
Eleanor E. Kennedy, MD#,
Luc R. Mongeon, PhD**,
Gerald A. Serwer, MD,
Hongyan Qiao**,
Bruce L. Wilkoff, MD for the PREFER Study Investigators
* St. Thomas Research Institute and University of Tennessee College of Medicine, Nashville, Tennessee
Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
Cardiology Associates of Corpus Christi, Corpus Christi, Texas
Department of Medicine, Winthrop University Hospital, Mineola, New York
|| The Heart Group, Lancaster, Pennsylvania
¶ Iowa Heart Center, Des Moines, Iowa
# Heart Clinic Arkansas, Little Rock, Arkansas
** Medtronic, Inc., Minneapolis, Minnesota
Department of Pediatrics, University of Michigan Congenital Heart Center, University of Michigan Health System, Ann Arbor, Michigan
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Manuscript received June 14, 2009;
revised manuscript received October 1, 2009,
accepted October 1, 2009.
* Reprint requests and correspondence: Dr. George H. Crossley, St. Thomas Research Institute, Suite 400, 222 22nd Avenue North, Nashville, Tennessee 37203 (Email: gcrossley{at}stthomasheart.com).
Objectives: The purpose of this study was to evaluate remote pacemaker interrogation for the earlier diagnosis of clinically actionable events compared with traditional transtelephonic monitoring and routine in-person evaluation.
Background: Pacemaker patient follow-up procedures have evolved from evaluating devices with little programmability and diagnostic information solely in person to transtelephonic rhythm strip recordings that allow monitoring of basic device function. More recently developed remote monitoring technology leverages expanded device capabilities, augmenting traditional transtelephonic monitoring to evaluate patients via full device interrogation.
Methods: The time to first diagnosis of a clinically actionable event was compared in patients who were followed by remote interrogation (Remote) and those who were followed per standard of care with office visits augmented by transtelephonic monitoring (Control). Patients were randomized 2:1. Remote arm patients transmitted pacemaker information at 3-month intervals. Control arm patients with a single-chamber pacemaker transmitted at 2-month intervals. Control arm patients with dual-chamber devices transmitted at 2-month intervals with an office visit at 6 months. All patients were seen in office at 12 months.
Results: The mean time to first diagnosis of clinically actionable events was earlier in the Remote arm (5.7 months) than in the Control arm (7.7 months). Three (2%) of the 190 events in the Control arm and 446 (66%) of 676 events in the Remote arm were identified remotely.
Conclusions: The strategic use of remote pacemaker interrogation follow-up detects actionable events that are potentially important more quickly and more frequently than transtelephonic rhythm strip recordings. The use of transtelephonic rhythm strips for pacemaker follow-up is of little value except for battery status determinations. (PREFER [Pacemaker Remote Follow-up Evaluation and Review]; NCT00294645)
Key Words: pacemaker • follow-up • remote follow-up
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Abbreviations and Acronyms
| | AT/AF = atrial tachycardia/atrial fibrillation | | CAE = clinically actionable event | | TTM = transtelephonic monitoring |
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