Advances in remote monitoring of implantable pacemakers, cardioverter defibrillators and cardiac resynchronization therapy systems

  • Werner Jung
  • Andreas Rillig
  • Ralf Birkemeyer
  • Tomislav Miljak
  • Udo Meyerfeldt


Unlike the standard quarterly or semi-annual direct ambulatory device interrogations procedures, state-of-the-art implantable electronic cardiovascular devices (IECD) enable their wireless remote interrogation and monitoring, and automatically send reports and special alerts on a daily basis. This allows physicians to respond more proactively to changes in patient or device status, more appropriately triage patient care, and more efficiently perform the post-implant ambulatory follow-ups. This review presents the-state-of the-art technology of remote IECD monitoring and summarizes the main clinical observations published through June 2008. Cardiovascular remote monitoring systems made by several manufacturers are currently in various phases of development, clinical investigation, and medical applications. Data collected in several completed and ongoing studies strongly suggest that this new technology will make important contributions, particularly with respect to the facilitation of IECD follow-ups, enhancement of patient safety and quality of life, and lowering of medical costs. Further technological advances and a more clear understanding and appreciation of the clinical and economic benefits of telecardiology, will likely increase sharply the use of remote IECD monitoring in upcoming years.


Telecardiology Remote monitoring Home monitoring Heart failure monitoring Pacemaker follow-up 


  1. 1.
    Wilkoff, B. L., Auricchio, A., Brugada, J., Cowie, M., Ellenbogen, K. A., Gillis, A. M., et al. (2008). HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (IECDs): description of techniques, indications, personnel, frequency and ethical considerations: developed in partnership with the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA); and in collaboration with the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC), the Heart Failure Association of ESC (HFA), and the Heart Failure Society of America (HFSA). Endorsed by the Heart Rhythm Society, the European Heart Rhythm Association (a registered branch of the ESC), the American College of Cardiology, the American Heart Association. Europace, 10(6), 707–725.PubMedCrossRefGoogle Scholar
  2. 2.
    Epstein, A. E., Dimarco, J. P., Ellenbogen, K. A., Estes, N. A., Freedman, R. A., Gettes, L. S., et al. (2008). ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation, 117(21), e350–e408.PubMedCrossRefGoogle Scholar
  3. 3.
    McAlister, F.A., Ezekowitz, J., Hooton, N., Vandermeer, B., Spooner, C., Dryden, D. M., et al. (2007). Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: A systematic review. Journal of the American Medical Association, 297(22), 2502–2514.PubMedCrossRefGoogle Scholar
  4. 4.
    Krahn, A. D., Klein, G. J., Skanes, A. C., & Yee, R. (2004). Insertable loop recorder use for detection of intermittent arrhythmias. Pacing and Clinical Electrophysiology, 27(5), 657–664.PubMedCrossRefGoogle Scholar
  5. 5.
    Abraham, W. T. (2006). New approaches to monitoring heart failure before symptoms appear. Reviews in Cardiovascular Medicine, 7(Suppl 1), S33–S41.PubMedGoogle Scholar
  6. 6.
    Lazarus, A. (2007). Remote, wireless, ambulatory monitoring of implantable pacemakers, cardioverter defibrillators, and cardiac resynchronization therapy systems: analysis of a worldwide database. Pacing and Clinical Electrophysiology, 30(Suppl 1), S2–S12.PubMedGoogle Scholar
  7. 7.
    Nielsen, J. C., Kottkamp, H., Zabel, M., Aliot, E., Kreutzer, U., Bauer, A., et al. (2008). Automatic home monitoring of implantable cardioverter defibrillators. Europace, 10(6), 729–735.PubMedCrossRefGoogle Scholar
  8. 8.
    Ellery, S., Pakrashi, T., Paul, V., & Sack, S. (2006). Predicting mortality and rehospitalization in heart failure patients with Home Monitoring: the Home CARE pilot study. Clinical Research in Cardiology; Official Journal of the German Cardiac Society, 95(Suppl 3), iii29–iii35.PubMedGoogle Scholar
  9. 9.
    Perings, C., Klein, G., Toft, E., Moro, C., Klug, D., Bocker, D., et al. (2006). The RIONI study rationale and design: Validation of the first stored electrograms transmitted via Home Monitoring in patients with implantable defibrillators. Europace, 8(4), 288–292.PubMedCrossRefGoogle Scholar
  10. 10.
    Ritter, O., & Bauer, W. R. (2006). Use of “IEGM online” in ICD patients—early detection of inappropriate classified ventricular tachycardia via Home Monitoring. Clinical Research in Cardiology; Official Journal of the German Cardiac Society, 95(7), 368–372.PubMedGoogle Scholar
  11. 11.
    Schoenfeld, M. H., Compton, S. J., Mead, R. H., Weiss, D. N., Sherfesee, L., Englund, J., et al. (2004). Remote monitoring of implantable cardioverter defibrillators: A prospective analysis. Pacing and Clinical Electrophysiology, 27(6 Pt 1), 757–763.PubMedCrossRefGoogle Scholar
  12. 12.
    Ypenburg, C., Bax, J. J., van der Wall, E. E., Schalij, M. J., & van Ereven, L. (2007). Intrathoracic impedance monitoring to predict decompensated heart failure. The American Journal of Cardiology, 99(4), 554–557.PubMedCrossRefGoogle Scholar
  13. 13.
    Small, R. (2006). Integrating monitoring into the infrastructure and workflow of routine practice: OptiVol. Reviews in Cardiovascular Medicine, 7(Suppl 1), S47–S55.PubMedGoogle Scholar
  14. 14.
    Wang, L. (2007). Fundamentals of intrathoracic impedance monitoring in heart failure. The American Journal of Cardiology, 99(10A), 3G–10G.PubMedCrossRefGoogle Scholar
  15. 15.
    Joseph, G. K., Wilkoff, B. L., Dresing, T., Burkhardt, J., & Khaykin, Y. (2004). Remote interrogation and monitoring of implantable cardioverter defibrillators. Journal of Interventional Cardiac Electrophysiology, 11(2), 161–166.PubMedCrossRefGoogle Scholar
  16. 16.
    Clark, R. A., Inglis, S. C., McAlister, F. A., Cleland, J. G., & Stewart, S. (2007). Telemonitoring or structured telephone support programmes for patients with chronic heart failure: Systematic review and meta-analysis. BMJ (Clinical Research Ed), 334(7600), 942.CrossRefGoogle Scholar
  17. 17.
    Brugada, P. (2006). What evidence do we have to replace in-hospital implantable cardioverter defibrillator follow-up? Clinical Research in Cardiology; Official Journal of the German Cardiac Society, 95(Suppl 3), iii3–iii9.PubMedGoogle Scholar
  18. 18.
    Ricci, R. P., Russo, M., & Santini, M. (2006). Management of atrial fibrillation: What are the possibilities of early detection with Home Monitoring? Clinical Research in Cardiology; Official Journal of the German Cardiac Society, 95(Suppl 3), iii10–iii16.PubMedGoogle Scholar
  19. 19.
    Varma, N., Stambler, B., & Chun, S. (2005). Detection of atrial fibrillation by implanted devices with wireless data transmission capability. Pacing and Clinical Electrophysiology, 28(Suppl. 1), S133–S136.PubMedCrossRefGoogle Scholar
  20. 20.
    Ricci, R. P., Morichelli, L., & Santini, M. (2008). Home monitoring remote control of pacemaker and implantable cardioverter defibrillator patients in clinical practice: Impact on medical management and health-care resource utilization. Europace, 10(2), 164–170.PubMedCrossRefGoogle Scholar
  21. 21.
    Calcagnini, G., Censi, F., Floris, M., Pignalberi, C., Ricci, R., Biancalana, G., et al. (2006). Evaluation of electromagnetic interference of GSM mobile phones with pacemakers featuring remote monitoring functions. Pacing and Clinical Electrophysiology, 29(4), 380–385.PubMedCrossRefGoogle Scholar
  22. 22.
    Elsner, C., Sommer, P., Piorkowski, C., Taborsky, M., Neuser, H., Bytesnik, J., et al. (2006). A prospective multicenter comparison trial of Home Monitoring against regular follow-up in MADIT II patients: additional visits and cost impact. Computers in Cardiology, 33, 241–244.Google Scholar
  23. 23.
    Varma, N. (2007). Rationale and design of a prospective study of the efficacy of a remote monitoring system used in implantable cardioverter defibrillator follow-up: The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) study. American Heart Journal, 154(6), 1029–1034.PubMedCrossRefGoogle Scholar
  24. 24.
    Fauchier, L., Sadoul, N., Kouakam, C., Briand, F., Chauvin, M., Babuty, D., et al. (2005). Potential cost savings by telemedicine-assisted long-term care of implantable cardioverter defibrillator recipients. Pacing and Clinical Electrophysiology, 28(Suppl. 1), S255–S259.PubMedCrossRefGoogle Scholar
  25. 25.
    The IMPACT of BIOTRONIK Home Monitoring Guided Anticoagulation on Stroke Risk in Patients With Implanted ICD and CRT-D Devices (IMPACT) (last accessed: July 14, 2008).
  26. 26.
    Neuzil, P., Taborsky, M., Holy, F., & Wallbrueck, K. (2008). Early automatic remote detection of combined lead insulation defect and ICD damage. Europace, 10(5), 556–557.PubMedCrossRefGoogle Scholar
  27. 27.
    Spencker, S., Mueller, D., Marek, A., & Zabel, M. (2007). Severe pacemaker lead perforation detected by an automatic home-monitoring system. European Heart Journal, 28(12), 1432.PubMedCrossRefGoogle Scholar
  28. 28.
    Zartner, P. A., Handke, R. P., Brecher, A. M., & Schneider, M. B. (2007). Integrated Home Monitoring predicts lead failure in a pacemaker dependent 4-year-old girl. Europace, 9(3), 192–193.PubMedCrossRefGoogle Scholar
  29. 29.
    Scholten, M. F., Thornton, A. S., Theuns, D. A., Res, J., & Jordaens, L. J. (2004). Twiddler’s syndrome detected by Home Monitoring device. Pacing and Clinical Electrophysiology, 27(8), 1151–1152.PubMedCrossRefGoogle Scholar
  30. 30.
    Siaplaouras, S., Buob, A., Neuberger, H. R., & Mewis, C. (2006). Remote detection of incessant slow VT with an ICD capable of Home Monitoring. Europace, 8(7), 512–514.PubMedCrossRefGoogle Scholar
  31. 31.
    Koos, R., Sinha, A. M., & Stellbrink, C. (2005). Home Monitoring in an ICD patient with incessant ventricular tachycardia. Zeitschrift fur Kardiologie, 94(7), 461–464.PubMedCrossRefGoogle Scholar
  32. 32.
    Chen, J., Wilkoff, B. L., Choucair, W., Cohen, T. J., Crossley, G. H., Johnson, W. B., et al. (2008). Design of the Pacemaker REmote Follow-up Evaluation and Review (PREFER) trial to assess the clinical value of the remote pacemaker interrogation in the management of pacemaker patients. Trials, 9, 18.PubMedCrossRefGoogle Scholar
  33. 33.
    CONNECT Study—clinical evaluation of remote notification to reduce time to clinical decision. (last accessed: July 14, 2008).
  34. 34.
    Yu, C. M., Wang, L., Chau, E., Chan, R. H., Kong, S. L., Tang, M. O., et al. (2005). Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation, 112(6), 841–848.PubMedCrossRefGoogle Scholar
  35. 35.
    Sensitivity of the InSync Sentry OptiVol Feature for the Prediction of Heart Failure (SENSE-HF). (last accessed: July 14, 2008).
  36. 36.
    Diagnostic Outcome Trial in Heart Failure (DOT-HF Trial). (last accessed: July 14, 2008).
  37. 37.
    Saxon, L. A., Boehmer, J. P., Neuman, S., & Mullin, C. M. (2007). Remote Active Monitoring in Patients with Heart Failure (RAPID-RF): Design and rationale. Journal of Cardiac Failure, 13(4), 241–246.PubMedCrossRefGoogle Scholar
  38. 38.
    Carlson, M. D., Wilkoff, B. L., Maisel, W. H., Carlson, M. D., Ellenbogen, K. A., Saxon, L. A., et al. (2006). Recommendations from the Heart Rhythm Society Task Force on Device Performance Policies and Guidelines Endorsed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) and the International Coalition of Pacing and Electrophysiology Organizations (COPE). Heart Rhythm, 3(10), 1250–1273.PubMedCrossRefGoogle Scholar
  39. 39.
    Ruffy, R. (2007). The device recalls nightmare: Help might be on the way. Pacing and Clinical Electrophysiology, 30(Suppl 1), S1.PubMedGoogle Scholar
  40. 40.
    Boriani, G., Diemberger, I., Martignani, C., Biffi, M., Valzania, C., Bertini, M., et al. (2008). Telecardiology and remote monitoring of implanted electrical devices: The potential for fresh clinical care perspectives. Journal of General Internal Medicine, 23(Suppl 1), 73–77.PubMedCrossRefGoogle Scholar
  41. 41.
    Heidbuchel, H., Lioen, P., Foulon, S., Huybrechts, W., Ector, J., Willems, R., et al. (2008). Potential role of remote monitoring for scheduled and unscheduled evaluations of patients with an implantable defibrillator. Europace, 10(3), 351–357.PubMedCrossRefGoogle Scholar
  42. 42.
    Res, J. C., Theuns, D. A., & Jordaens, L. (2006). The role of remote monitoring in the reduction of inappropriate implantable cardioverter defibrillator therapies. Clinical Research in Cardiology; Official Journal of the German Cardiac Society, 95(Suppl 3), iii17–iii21.PubMedGoogle Scholar
  43. 43.
    Page, E., Cazeau, S., Ritter, P., Galley, D., & Casset, C. (2007). Physiological approach to monitor patients in congestive heart failure: Application of a new implantable device-based system to monitor daily life activity and ventilation. Europace, 9(8), 687–693.PubMedCrossRefGoogle Scholar
  44. 44.
    Halimi, F., Clementy, J., Attuel, P., Dessenne, X., & Amara, W. (2007). Post-implant fast hospital discharge: The Oedipe trial. Giornale Italiano di Aritmologia e Cardiostimolazione, 10(3, Suppl 2), 20, Abstract.Google Scholar
  45. 45.
    Deharo, J. C., & Djiane, P. (2006). Home Monitoring: what can we expect in the future? Clinical Research in Cardiology; Official Journal of the German Cardiac Society, 95(Suppl 3), iii36–iii39.PubMedGoogle Scholar
  46. 46.
    Steinhaus, D., Reynolds, D. W., Gadler, F., Kay, G. N., Hess, M. F., & Bennett, T. (2005). Implant experience with an implantable hemodynamic monitor for the management of symptomatic heart failure. Pacing and Clinical Electrophysiology, 28(8), 747–753.PubMedCrossRefGoogle Scholar
  47. 47.
    Bourge, R. C., Abraham, W. T., Adamson, P. B., Aaron, M. F., Aranda, J. M., Magalski, A., et al. (2008). Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: The COMPASS-HF study. Journal of the American College of Cardiology, 51(11), 1073–1079.PubMedCrossRefGoogle Scholar
  48. 48.
    Zima, E., Lippert, M., Czygan, G., & Merkely, B. (2006). Determination of left ventricular volume changes by intracardiac conductance using a biventricular electrode configuration. Europace, 8(7), 537–544.PubMedCrossRefGoogle Scholar
  49. 49.
    Stahl, C., Beierlein, W., Walker, T., Straub, A., Nagy, Z., Knubben, K., et al. (2007). Intracardiac impedance monitors hemodynamic deterioration in a chronic heart failure pig model. Journal of Cardiovascular Electrophysiology, 18(9), 985–990.PubMedCrossRefGoogle Scholar
  50. 50.
    Kjellstrom, B., Linde, C., Bennett, T., Ohlsson, A., & Ryden, L. (2004). Six years follow-up of an implanted SvO(2) sensor in the right ventricle. European Journal of Heart Failure, 6(5), 627–634.PubMedGoogle Scholar
  51. 51.
    Delnoy, P. P., Marcelli, E., Oudeluttikhuis, H., Nicastia, D., Renesto, F., Cercenelli, L., et al. (2008). Validation of a peak endocardial acceleration-based algorithm to optimize cardiac resynchronization: Early clinical results. Europace, 10(7), 801–808.PubMedCrossRefGoogle Scholar
  52. 52.
    Asbach, S., Weiss, I., Wenzel, B., Bode, C., & Zehender, M. (2006). Intrathoracic far-field electrocardiogram allows continuous monitoring of ischemia after total coronary occlusion. Pacing and Clinical Electrophysiology, 29(12), 1334–1340.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Werner Jung
    • 1
  • Andreas Rillig
    • 1
  • Ralf Birkemeyer
    • 1
  • Tomislav Miljak
    • 1
  • Udo Meyerfeldt
    • 1
  1. 1.Department of CardiologyAcademic Teaching Hospital Villingen of the University of FreiburgVillingen-SchwenningenGermany

Personalised recommendations