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Pol. Merkur. Lek (Pol. Med. J.), 2016, XL/237: 153-159 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2016, XL/237: 153-159

Title: Safety and efficacy of classic ambulatory implantable cardioverter- defibrillator and resynchronisation systems follow-up compared to telemetric follow-up

Authors: Lelakowski J, Rydlewska A, Piekarz J, Lelakowska-Pieła M, Pudło J. 

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN POLISH.

Safety and efficacy of classic ambulatory implantable cardioverter- defibrillator and resynchronisation systems follow-up compared to telemetric follow-up

Lelakowski J1, Rydlewska A1, Piekarz J2, Lelakowska-Pieła M3, Pudło J1.

1Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków; 2Department of Electrocardiology, The John Paul II Hospital in Kraków; 3The John Paul II Hospital in Kraków

Telemetric follow-up (RM) after cardiac devices implantation is not only not inferior to classic follow-up, but also enables earlier clinical complications detection and stricter patient monitoring.
The aim of the study
was to confirm safety and efficacy of RM in patients with implantable cardioverter-defibrillator (ICD) or cardioverterdefibrillator with resynchronisation therapy (CRT-D), compared to traditional follow-up in outpatient clinic.
Material and methods
. Group A (CRT-D+ICD) (retrospective, patients followed-up in outpatient clinic) was consisted with 273 patients (mean age 65±11 years, 230M). Group A included 128 patients after CRT-D implantation and 145 patients with ICD. Group B (RM group) (prospective, RM Medtronic CareLink follow-up) involved 89 patients (mean age 61±14 years, 73M). 11 patients had CRT-D and 78 had ICD implanted. Only patients with Medtronic equipment were included to group B. Follow-up of patients from group A – ambulatory visit in outpatient clinic: 1-3 months after implantation, then every 6 months. Follow-up of patients from group B – daily follow-up using RM system (Medtronic CareLink). Patient’s clinical status, medications, frequency/ type of arrhythmias, device interventions were assessed in both groups.
Results
. To assess presence of ventricular arrhythmia, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, a number of patients were randomly chosen from group A. They were similar in age, gender, LVEF value, NYHA class, comorbidities, time of follow-up (control group) to Group B (RM group). In the RM group, compared to control group, there were significantly less programming changes (3,4 vs 28,6%, p<0,001), time to first event was shorter (ventricular arrhythmia – 39 days, p<0,001; intervention – 102 days, p<0,001), time to first necessary programming change was longer (201 days, p<0,001). RM system proved to be save, more accurate (22% visits were performed personally by the physician operating Medtronic CareLink system, 71,4% consultations were performed via internet, phone), and general mortality did not differ significantly between the groups (p=0,147).
Conclusions
. Telemetric follow-up of cardiac implantable devices is a safe and more accurate method in comparison to classic ambulatory follow-up. Telemetric follow-up of cardiac implantable devices enables quick information transmission in case of clinical complications (arrhythmia, intervention). Telemetric follow-up allows to reduce number of ambulatory visits to only necessary ones.

Key words: Telemetric follow-up, ICD, CRTD, traditional follow-up in outpatient clinic

Pol Med J, 2016; XL (237); 153–159