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. 2019 Jan 15;10(1):3477-3484.
doi: 10.19102/icrm.2019.100102. eCollection 2019 Jan.

Remote Control of Cardiac Implantable Electronic Devices: Exploring the New Frontier-First Clinical Application of Real-time Remote-control Management of Cardiac Devices Before and After Magnetic Resonance Imaging

Esteban M Kloosterman  1   2 , Murray Rosenbaum  1 , Brian La Starza  1 , Jamil Wilcox  1 , Jonathan Rosman  1
Affiliations

Remote Control of Cardiac Implantable Electronic Devices: Exploring the New Frontier-First Clinical Application of Real-time Remote-control Management of Cardiac Devices Before and After Magnetic Resonance Imaging

Esteban M Kloosterman et al. J Innov Card Rhythm Manag. .

Abstract

The purpose of the present study was to evaluate the performance of remote-control (RC) management of cardiac implantable electronic devices (CIEDs) in clinical practice using a new service model in patients undergoing magnetic resonance imaging (MRI) scans. The number of CIEDs is constantly growing, alongside the demands for prompt checks. Although remote CIED interrogation exists, ultimately, real-time remote management is the goal. In this study, patients with MRI-conditional devices suitable for RC interaction who required an MRI were enrolled. An onsite technician began the RC session by contacting the remote operator, applying the programmer wand, and keying in an access code. The device was remotely checked via encrypted Wi-Fi by an electrophysiologist using a laptop. An MRI-safe mode was programmed per a preestablished proprietary algorithm. Following the scan, patient devices were remotely reinterrogated and reprogrammed to baseline, with adjustments made as clinically necessary. Patients subsequently were asked to complete a survey. Ultimately, a total of 100 RC CIED reprogrammings were performed in 50 MRI sessions, prescan and postscan. The average RC time interaction was four minutes prescan and three minutes postscan, respectively. No complications occurred. Five patients had more than one MRI in this study and 15 patients had had previous MRIs. In eight patients, baseline settings were reprogrammed. Most patients (82%) were very satisfied, preferring device specialist remote management. Only 14 (32%) patients used home remote monitoring. In conclusion, RC management of CIEDs in the MRI setting is feasible, safe, and clinically relevant. Use of the MRI mode determination algorithm was safe, consistent, and efficient. Expanding RC in CIED management for service anytime, anywhere is the next challenge.

Keywords: CIED programming; MRI-safe mode algorithm; remote control; remote monitoring.

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Conflict of interest statement

Dr. Kloosterman receives modest honoraria as a speaker and advisor for Medtronic, Boston Scientific, and Abbott Laboratories. The other authors report no conflicts of interest for the published content. The work reported in this manuscript is part of a physician initiative study that received funding from an educational grant from Medtronic (3504 ERP). The company otherwise had no interaction, opinion, or intervention with regard to the protocol design, study proceedings, or preparation of this manuscript. The study was approved by an investigational review board (human studies/ethics committee).

Figures

Figure 1:
Figure 1:
Workflow layout of the present study evaluating RC management of cardiac devices pre- and post-MRI.
Figure 2:
Figure 2:
The algorithm for the selection of the MRI-safe scan mode in the case of dual-chamber DDD or single-chamber VVI modes.
Figure 3:
Figure 3:
“Programmer” for the remote management of MRI-conditional cardiac devices. A: This computer had a connectivity modem card with options of intranet cable connection or a dedicated Wi-Fi cellular hotspot. The session was initiated by a bedside technician. B: Once informed that the patient was ready, the remote operator logged onto the session to access the RC functions of the programmer.
Figure 4:
Figure 4:
MRI-safe mode programming distribution using the provided algorithm.
See this image and copyright information in PMC

References

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