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Erschienen in: Herzschrittmachertherapie + Elektrophysiologie 2/2015

01.06.2015 | Schwerpunkt

Implantierbarer Kardioverter-Defibrillator

Heute immer mit Telemonitoring?

verfasst von: Dr. Fritz W. Horlbeck, M.D., J.O. Schwab, M.D.

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 2/2015

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Zusammenfassung

Hintergrund

Die Möglichkeiten des Telemonitoring (TM) von Patienten mit implantierbaren Kardioverter-Defibrillatoren (ICD) haben sich in den letzten Jahren rasant entwickelt, und die Auswirkungen auf die Nachsorge von ICD-Patienten wurden inzwischen in zahlreichen Studien untersucht.

Fragestellung

Technische Umsetzung und Sicherheit von TM bei ICDs. Auswirkungen auf die Therapie kardialer Arrhythmien, auf das Management von Herzinsuffizienzpatienten sowie auf Morbidität und Mortalität. Darstellung der Patientenakzeptanz sowie eine Kosten-Nutzen-Bewertung.

Material und Methoden

Analyse der aktuellen Studienlage zum TM von ICDs sowie Diskussion der vorliegenden Evidenz für die postulierten Vorteile in der Nachsorge von ICD-Patienten. Darstellung des aktuellen Standes der kardiologischen Therapieleitlinien sowie Hinweise zur Umsetzung von TM im klinischen Alltag.

Ergebnisse und Diskussion

Durch den Einsatz von TM besteht die Möglichkeit einer schnelleren Reaktion auf Arrhythmien, kardiale Dekompensationen und ICD-Fehlfunktionen. Gleichzeitig kann die Frequenz ambulanter Nachsorgen ohne Sicherheitsverlust bei gleichzeitig guter Lebensqualität und Patientenakzeptanz reduziert werden. TM hat das Potenzial zur kostenneutralen Verbesserung der Sicherheit der ICD-Therapie und eines optimierten Managements von Herzinsuffizienzpatienten mit Senkung der Morbidität und Mortalität. Der Nachweis dieser Vorteile in zahlreichen Studien führte bereits zur Implementierung in den aktuellen Therapieleitlinien.
Literatur
1.
Zurück zum Zitat Boriani G, Da Costa A, Ricci RP et al (2013) The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) randomized controlled trial: phase 1 results on dynamics of early intervention with remote monitoring. J Med Internet Res 15:e167PubMedCentralPubMedCrossRef Boriani G, Da Costa A, Ricci RP et al (2013) The MOnitoring Resynchronization dEvices and CARdiac patiEnts (MORE-CARE) randomized controlled trial: phase 1 results on dynamics of early intervention with remote monitoring. J Med Internet Res 15:e167PubMedCentralPubMedCrossRef
2.
Zurück zum Zitat Brachmann J, Bohm M, Rybak K et al (2011) Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink). Eur J Heart Fail 13:796–804PubMedCentralPubMedCrossRef Brachmann J, Bohm M, Rybak K et al (2011) Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink). Eur J Heart Fail 13:796–804PubMedCentralPubMedCrossRef
3.
Zurück zum Zitat Conraads VM, Tavazzi L, Santini M et al (2011) Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial. Eur Heart J 32:2266–2273PubMedCrossRef Conraads VM, Tavazzi L, Santini M et al (2011) Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial. Eur Heart J 32:2266–2273PubMedCrossRef
4.
Zurück zum Zitat Crossley GH, Boyle A, Vitense H et al (2011) The CONNECT (Clinical evaluation of remote notification to reduce time to clinical decision) trial: the value of wireless remote monitoring with automatic clinician alerts. J Am Coll Cardiol 57:1181–1189PubMedCrossRef Crossley GH, Boyle A, Vitense H et al (2011) The CONNECT (Clinical evaluation of remote notification to reduce time to clinical decision) trial: the value of wireless remote monitoring with automatic clinician alerts. J Am Coll Cardiol 57:1181–1189PubMedCrossRef
5.
Zurück zum Zitat Dubner S, Auricchio A, Steinberg JS et al (2012) ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs). Ann Noninvasive Electrocardiol 17:36–56PubMedCrossRef Dubner S, Auricchio A, Steinberg JS et al (2012) ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs). Ann Noninvasive Electrocardiol 17:36–56PubMedCrossRef
6.
Zurück zum Zitat European Heart Rhythm Association, European Society of Cardiology, Heart Rhythm Society et al (2012) 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm 9:1524–1576CrossRef European Heart Rhythm Association, European Society of Cardiology, Heart Rhythm Society et al (2012) 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm 9:1524–1576CrossRef
7.
Zurück zum Zitat European Society of Cardiology, European Heart Rhythm Association; Brignole M et al (2013) 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 15:1070–1118CrossRef European Society of Cardiology, European Heart Rhythm Association; Brignole M et al (2013) 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 15:1070–1118CrossRef
8.
Zurück zum Zitat Guedon-Moreau L, Kouakam C, Klug D et al (2014) Decreased delivery of inappropriate shocks achieved by remote monitoring of ICD: a substudy of the ECOST trial. J Cardiovasc Electrophysiol 25:763–770PubMedCrossRef Guedon-Moreau L, Kouakam C, Klug D et al (2014) Decreased delivery of inappropriate shocks achieved by remote monitoring of ICD: a substudy of the ECOST trial. J Cardiovasc Electrophysiol 25:763–770PubMedCrossRef
9.
Zurück zum Zitat Guedon-Moreau L, Lacroix D, Sadoul N et al (2013) A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial. Eur Heart J 34:605–614PubMedCentralPubMedCrossRef Guedon-Moreau L, Lacroix D, Sadoul N et al (2013) A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial. Eur Heart J 34:605–614PubMedCentralPubMedCrossRef
10.
Zurück zum Zitat Heidbuchel H, Hindricks G, Broadhurst P et al (2015) EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. Eur Heart J 36:158–169PubMedCentralPubMedCrossRef Heidbuchel H, Hindricks G, Broadhurst P et al (2015) EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. Eur Heart J 36:158–169PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Hernandez-Madrid A, Lewalter T, Proclemer A et al (2014) Remote monitoring of cardiac implantable electronic devices in Europe: results of the European heart rhythm association survey. Europace 16:129–132PubMedCrossRef Hernandez-Madrid A, Lewalter T, Proclemer A et al (2014) Remote monitoring of cardiac implantable electronic devices in Europe: results of the European heart rhythm association survey. Europace 16:129–132PubMedCrossRef
12.
Zurück zum Zitat Hindricks G, Elsner C, Piorkowski C et al (2014) Quarterly vs. yearly clinical follow-up of remotely monitored recipients of prophylactic implantable cardioverter-defibrillators: results of the REFORM trial. Eur Heart J 35:98–105PubMedCentralPubMedCrossRef Hindricks G, Elsner C, Piorkowski C et al (2014) Quarterly vs. yearly clinical follow-up of remotely monitored recipients of prophylactic implantable cardioverter-defibrillators: results of the REFORM trial. Eur Heart J 35:98–105PubMedCentralPubMedCrossRef
13.
Zurück zum Zitat Hindricks G, Taborsky M, Glikson M et al (2014) Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 384:583–590PubMedCrossRef Hindricks G, Taborsky M, Glikson M et al (2014) Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 384:583–590PubMedCrossRef
14.
Zurück zum Zitat Ip J, Waldo AL, Lip GY et al (2009) Multicenter randomized study of anticoagulation guided by remote rhythm monitoring in patients with implantable cardioverter-defibrillator and CRT-D devices: Rationale, design, and clinical characteristics of the initially enrolled cohort The IMPACT study. Am Heart J 158:364–370e361PubMedCrossRef Ip J, Waldo AL, Lip GY et al (2009) Multicenter randomized study of anticoagulation guided by remote rhythm monitoring in patients with implantable cardioverter-defibrillator and CRT-D devices: Rationale, design, and clinical characteristics of the initially enrolled cohort The IMPACT study. Am Heart J 158:364–370e361PubMedCrossRef
15.
Zurück zum Zitat Koneru JN, Gunderson BD, Sachanandani H et al (2013) Diagnosis of high-voltage conductor fractures in Sprint Fidelis leads. Heart Rhythm 10:813–818PubMedCrossRef Koneru JN, Gunderson BD, Sachanandani H et al (2013) Diagnosis of high-voltage conductor fractures in Sprint Fidelis leads. Heart Rhythm 10:813–818PubMedCrossRef
16.
Zurück zum Zitat Landolina M, Perego GB, Lunati M et al (2012) Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation 125:2985–2992PubMedCrossRef Landolina M, Perego GB, Lunati M et al (2012) Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation 125:2985–2992PubMedCrossRef
18.
Zurück zum Zitat Mairesse GH, Braunschweig F, Klersy K et al (2015) Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace Mairesse GH, Braunschweig F, Klersy K et al (2015) Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace
19.
Zurück zum Zitat Morgan JM, Dimitrov BD, Gill J et al (2014) Rationale and study design of the REM-HF study: remote management of heart failure using implanted devices and formalized follow-up procedures. Eur J Heart Fail 16:1039–1045PubMedCrossRef Morgan JM, Dimitrov BD, Gill J et al (2014) Rationale and study design of the REM-HF study: remote management of heart failure using implanted devices and formalized follow-up procedures. Eur J Heart Fail 16:1039–1045PubMedCrossRef
20.
Zurück zum Zitat Mueller A, Rybak K, Klingenheben T et al. (2013) Empfehlungen zum Telemonitoring bei Patienten mit implantierten Herzschrittmachern, Defibrillatoren und kardialen Resynchronisationssystemen. Kardiologe 7:181–193CrossRef Mueller A, Rybak K, Klingenheben T et al. (2013) Empfehlungen zum Telemonitoring bei Patienten mit implantierten Herzschrittmachern, Defibrillatoren und kardialen Resynchronisationssystemen. Kardiologe 7:181–193CrossRef
21.
Zurück zum Zitat Ricci RP, Morichelli L, D'onofrio A et al (2013) Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry. Europace 15:970–977PubMedCentralPubMedCrossRef Ricci RP, Morichelli L, D'onofrio A et al (2013) Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry. Europace 15:970–977PubMedCentralPubMedCrossRef
22.
Zurück zum Zitat Ricci RP, Morichelli L, D'onofrio A et al (2014) Manpower and outpatient clinic workload for remote monitoring of patients with cardiac implantable electronic devices: data from the HomeGuide Registry. J Cardiovasc Electrophysiol 25:1216–1223PubMedCrossRef Ricci RP, Morichelli L, D'onofrio A et al (2014) Manpower and outpatient clinic workload for remote monitoring of patients with cardiac implantable electronic devices: data from the HomeGuide Registry. J Cardiovasc Electrophysiol 25:1216–1223PubMedCrossRef
23.
Zurück zum Zitat Rosenfeld LE, Patel AS, Ajmani VB et al (2014) Compliance with remote monitoring of ICDS/CRTDS in a real-world population. Pacing Clin Electrophysiol 37:820–827PubMedCrossRef Rosenfeld LE, Patel AS, Ajmani VB et al (2014) Compliance with remote monitoring of ICDS/CRTDS in a real-world population. Pacing Clin Electrophysiol 37:820–827PubMedCrossRef
24.
Zurück zum Zitat Saxon LA, Hayes DL, Gilliam FR et al (2010) Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: the ALTITUDE survival study. Circulation 122:2359–2367PubMedCrossRef Saxon LA, Hayes DL, Gilliam FR et al (2010) Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: the ALTITUDE survival study. Circulation 122:2359–2367PubMedCrossRef
25.
Zurück zum Zitat Siebermair J, Clauss S, Martens E et al (2014) Remote monitoring of implantable cardioverter-defibrillators: problems and implications using a telemonitoring system. Herz Siebermair J, Clauss S, Martens E et al (2014) Remote monitoring of implantable cardioverter-defibrillators: problems and implications using a telemonitoring system. Herz
26.
Zurück zum Zitat Spencker S, Coban N, Koch L et al (2009) Potential role of home monitoring to reduce inappropriate shocks in implantable cardioverter-defibrillator patients due to lead failure. Europace 11:483–488PubMedCrossRef Spencker S, Coban N, Koch L et al (2009) Potential role of home monitoring to reduce inappropriate shocks in implantable cardioverter-defibrillator patients due to lead failure. Europace 11:483–488PubMedCrossRef
27.
Zurück zum Zitat Van Veldhuisen DJ, Braunschweig F, Conraads V et al (2011) Intrathoracic impedance monitoring, audible patient alerts, and outcome in patients with heart failure. Circulation 124:1719–1726PubMedCrossRef Van Veldhuisen DJ, Braunschweig F, Conraads V et al (2011) Intrathoracic impedance monitoring, audible patient alerts, and outcome in patients with heart failure. Circulation 124:1719–1726PubMedCrossRef
28.
Zurück zum Zitat Varma N (2013) Automatic remote home monitoring of implantable cardioverter defibrillator lead and generator function: a system that tests itself everyday. Europace 15(Suppl 1):i26–i31PubMedCrossRef Varma N (2013) Automatic remote home monitoring of implantable cardioverter defibrillator lead and generator function: a system that tests itself everyday. Europace 15(Suppl 1):i26–i31PubMedCrossRef
29.
Zurück zum Zitat Varma N, Epstein AE, Irimpen A et al (2010) Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up: the Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) trial. Circulation 122:325–332PubMedCrossRef Varma N, Epstein AE, Irimpen A et al (2010) Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up: the Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) trial. Circulation 122:325–332PubMedCrossRef
30.
Zurück zum Zitat Whellan DJ, Ousdigian KT, Al-Khatib SM et al (2010) Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: results from PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study. J Am Coll Cardiol 55:1803–1810PubMedCrossRef Whellan DJ, Ousdigian KT, Al-Khatib SM et al (2010) Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: results from PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study. J Am Coll Cardiol 55:1803–1810PubMedCrossRef
31.
Zurück zum Zitat Wilkoff BL, Auricchio A, Brugada J et al (2008) HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs): 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 10:707–725PubMedCrossRef Wilkoff BL, Auricchio A, Brugada J et al (2008) HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs): 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 10:707–725PubMedCrossRef
32.
Zurück zum Zitat Zabel M, Muller-Riemenschneider F, Geller JC et al (2014) Rationale and design of the MONITOR-ICD study: a randomized comparison of economic and clinical effects of automatic remote MONITORing versus control in patients with Implantable Cardioverter Defibrillators. Am Heart J 168:430–437PubMedCrossRef Zabel M, Muller-Riemenschneider F, Geller JC et al (2014) Rationale and design of the MONITOR-ICD study: a randomized comparison of economic and clinical effects of automatic remote MONITORing versus control in patients with Implantable Cardioverter Defibrillators. Am Heart J 168:430–437PubMedCrossRef
33.
Zurück zum Zitat Zabel M, Vollmann D, Luthje L et al (2013) Randomized Clinical evaluatiON of wireless fluid monitoriNg and rEmote ICD managemenT using OptiVol alert-based predefined management to reduce cardiac decompensation and health care utilization: the CONNECT-OptiVol study. Contemp Clin Trials 34:109–116PubMedCrossRef Zabel M, Vollmann D, Luthje L et al (2013) Randomized Clinical evaluatiON of wireless fluid monitoriNg and rEmote ICD managemenT using OptiVol alert-based predefined management to reduce cardiac decompensation and health care utilization: the CONNECT-OptiVol study. Contemp Clin Trials 34:109–116PubMedCrossRef
Metadaten
Titel
Implantierbarer Kardioverter-Defibrillator
Heute immer mit Telemonitoring?
verfasst von
Dr. Fritz W. Horlbeck, M.D.
J.O. Schwab, M.D.
Publikationsdatum
01.06.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 2/2015
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI
https://doi.org/10.1007/s00399-015-0368-4

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