Findings of an observational investigation of pure remote follow-up of pacemaker patients: is the in-clinic device check still needed?

BACKGROUND: Device follow-up is mandatory in the care of patients with a pacemaker. However, in most cases, device checks appear to be mere technical, time-consuming procedures. The aim of this research is to evaluate whether remote follow-up can replace in-clinic device checks by assessing clinical outcomes for pacemaker patients followed only via remote follow-up. METHODS AND RESULTS: Consecutive pacemaker patients followed with remote monitoring were prospectively included by 6 Italian cardiology centers in an observational investigation. The workflow for remote monitoring included an initial assessment by nursing staff and, when necessary, by a responsible physician for medical decisions. No in-person visits were scheduled after the start of remote monitoring. One-thousand and two-hundred and fifty one patients (30% female, 75±11years old) were followed for a median observation period of 15months. Out of 4965 remote transmissions, 1882 (38%) had at least one clinically relevant event to be investigated further, but, only after 137 transmissions (2.8%), the patients were contacted for an in-clinic visit or hospitalization. Sixty-nine patients died and 124 were hospitalized for various reasons. Atrial fibrillation episodes were the most common clinical events discovered by remote transmissions, occurring in 1339 (26%) transmissions and 471 (38%) patients. CONCLUSIONS: Our experience shows that remote monitoring in a pacemaker population can safely replace in-clinic follow-up, avoiding unnecessary in-hospital device follow-up.

Biventricular pacing and atrioventricular junction ablation as treatment of low output syndrome due to refractory congestive heart failure and chronic atrial fibrillation.

A 71-year-old male patient with end-stage heart failure, atrial fibrillation, congestive and low output symptoms, underwent biventricular pacing and atrioventricular junction ablation while anuric and hypotensive. Following atrioventricular junction ablation blood pressure increased by 20 mmHg during biventricular but not during right ventricular apical pacing. A rapid clinical improvement was observed and the patient was discharged from the hospital in NYHA functional class III.