Cardiovascular implantable electronic device monitoring: Is an ounce of prevention worth a pound of cure?

摘要

The prevalence of pacemakers and implantable cardioverter-defibrillators (ICDs) continues to rise rapidly as do the logistics of monitoring such devices. An estimated 3.3 million pacemaker and 2.6 million ICD follow-up encounters are undertaken in North America and Europe each year (European Medical Technology Industry Association, unpublished data). The 2008 Heart Rhythm Society/ European Heart Rhythm Association Expert Consensus statement on monitoring of cardiovascular implantable electronic devices (CIEDs) provides guidance for follow-up.1 This document emphasizes that the goals of CIED monitoring are patient related (eg, optimize device function for clinical requirements and enact safety alerts), CIED related (eg, confirm appropriate CIED function and maximize pulse generator longevity), disease related (eg, document arrhythmias and CIED response), and communication related (eg, maintain patient database, update patients and health-care providers). The 2008 expert consensus statement also provides the recommended minimum frequency of CIED monitoring: within 72 hours of CIED implantation (in-person), 2-12 weeks postimplantation (in-person), followed thereafter every 3-12 months for pacemaker/cardiac resynchronization therapy-pacemaker follow-up and every 3-6 months for ICD/cardiac resynchronization therapy-defibrillator (CRT-D) follow-up (in-person or remote) with inclusion of at least 1 in-person annual follow-up.