Response to medical therapy may be disclosed, such as for atrial fibrillation (AF). ![]() Device function, including capture and sensing thresholds, may be reviewed (Table 32-1). ![]() This has been traditionally wand-based but more recently, with wireless telemetry using a programmer located within 10 feet (3 m). Interrogation of the device is performed using a programmer for bidirectional communication with the CIED. Face-to-face evaluation permits history taking, physical examination, electrocardiography, and radiography as indicated. In-person monitoring with a physician or allied professional in a clinic or medical institution has been the conventional standard for device follow-up. 3, 4 These place increasing demands on the health care system. Significant challenges are increasing volume of patients, complexity of both CIED and patient, maintaining continuous surveillance, capability of prompt problem detection, and management of retrieved data. For ICDs and CRT devices, this is performed at short intervals because of safety concerns (e.g., 3 monthly), although optimal frequency has not been tested. Current practice generally follows an in-clinic follow-up protocol by physicians and specially trained staff with retrieval of stored diagnostic data. The aims of monitoring are to (1) establish and maintain appropriate CIED function, (2) optimize its programming, (3) identify risks in implanted device (e.g., impending lead failure) or from changes in patient condition (e.g., advent of AF), (4) monitor response to therapy, and (5) provide a communication channel for systematic data review. ![]() Despite this, physician and patient interest has generally focused on the acute implant itself. Extension of this to CIED therapy implies implementation of careful postimplant monitoring and timely response to any changing need. Ī guiding principle of medical therapy is the requirement for monitoring both the action of the therapy and the condition of the patient. Recently, data to guide postimplant follow-up have emerged from prospective trials testing conventional follow-up as well as the value of remote monitoring mechanisms. Collective experience has led to the evolution of specialized CIED follow-up clinics staffed by trained physicians and device specialists. However, CIED follow-up has not been standardized. Concomitantly, improved CIED monitoring mechanisms are needed for timely retrieval of important diagnostic data and rigorous assessment of system performance to ensure patient safety. 2Ĭurrent CIEDs have a sophisticated capacity to identify, quantify, and present diagnostic data regarding their own performance as well as the patient’s condition (e.g., arrhythmias, hemodynamic parameters). An estimated 1 million devices were implanted in 2007, and this number will increase as their range and versatility increase. ![]() Positive results from recent trials for prophylactic ICDs and cardiac resynchronization therapy (CRT) devices have driven an expansion of indications and spurred an exponential increase in CIED use. Functional roles may overlap, and capabilities for ventricular tachyarrhythmia therapy, biventricular stimulation, and collection of heart failure monitoring data may be contained in a single device. 1 Since their inception in 1958, the function of CIEDs and monitoring of patients have become more complex. Implantation is indicated for treatment, diagnosis, and monitoring of bradycardia, tachycardia, and most recently, heart failure. Cardiovascular implantable electronic devices (CIEDs) include cardiac pacemakers, implantable cardioverter-defibrillators (ICDs), and leadless devices such as implantable loop recorders and cardiovascular monitors.
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