ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs)

Abstract

We are in the midst of a rapidly evolving era of technology-assisted medicine. The field of telemedicine provides the opportunity for highly individualized medical management in a way that has never been possible before. Evolving medical technologies using cardiac implantable devices with capabilities for remote monitoring permit evaluation of multiple parameters of cardiovascular physiology and risk, including cardiac rhythm, device function, blood pressure values, the presence of myocardial ischaemia, and the degree of compensation of congestive heart failure. Cardiac risk, device status, and response to therapies can now be assessed with these electronic systems of detection and reporting. This document reflects the extensive experience from investigators and innovators around the world who are shaping the evolution of this rapidly expanding field, focusing in particular on implantable pacemakers, implantable cardioverter defibrillators, devices for cardiac resynchronization therapy (both with and without defibrillation properties), loop recorders, and hemodynamic monitoring devices. This document covers the basic methodologies, guidelines for their use, experience with existing applications, and the legal and reimbursement aspects associated with their use. To adequately cover this important emerging topic, the International Society for Holter and Noninvasive Electrocardiology and the European Heart Rhythm Association combined their expertise in this field. We hope that the development of this field can contribute to improve care of our cardiovascular patients.

Figure 1

(a), (b), and (c) Implanted cardiac devices per million inhabitants in Europe. Reproduced with permission from Eucomed. ³

Figure 2

Different systems available for remote monitoring. Images reproduced with permission of the suppliers.

Figure 3

Legend HM versus conventional care [days]: AF: median, 5.5 versus 40; interquartile range, 1–51.25 versus 15.5–59; VT: median, 1 versus 28; interquartile range, 1–6 versus 6.5–69.25; VF: median, 1 versus 36; interquartile range, 1–7 versus 10–75; SVT: median, 2 versus 39; interquartile range, 1–19.5 versus 8.5–69. Clinically asymptomatic(silent) problems were also detected early in HM for combined first AF, VT, VF, or SVT events (median, 1 vs. 41.5; interquartile range, 1–6 vs. 10.5–70.25). Compiled with permission from Varma et al. ⁴⁸