scholarly journals Remote Monitoring of Heart Failure in Patients with Implantable Cardioverter-Defibrillators: Current Status and Future Needs

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3763
Author(s):  
Dominic A. M. J. Theuns ◽  
Sumant P. Radhoe ◽  
Jasper J. Brugts
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Point Of View ◽  
Cardiac Resynchronization ◽  
Current Status ◽  
Ambulatory Setting ◽  
Implantable Cardioverter Defibrillators ◽  
Frequent Monitoring ◽  
The Impact ◽  
Cardioverter Defibrillators

The management of heart failure remains challenging despite evidence-based medical and pharmacological advances, especially in the ambulatory setting. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates due to heart failure. Frequent monitoring of high-risk patients is imperative, and with the development of wireless and remote technology, frequent monitoring is now possible via remote monitoring. Nowadays, remote management of patients with cardiac implantable electronic devices is being increasingly adopted and integrated into clinical practice. Several clinical trials studied the impact of remote monitoring on clinical outcomes in patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization defibrillators (CRT-Ds). This point of view will focus on the remote monitoring of ICDs and CRT-Ds in patients with heart failure and discusses whether remote monitoring can be used as a potential instrument for the early identification of patients at risk of worsening heart failure.

scholarly journals Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in the Treatment of Heart Failure with Reduced Ejection Fraction

2017 ◽  
Vol 10 ◽  
Author(s):  
Ilaria Spoletini ◽  
Andrew Coats
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Resynchronization Therapy ◽  
Device Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Cardioverter Defibrillators

It has been long acknowledged that electrical-conduction disturbances may be both a cause of heart failure and a consequence of it. In fact, many patients with heart failure have an asynchronous contraction pattern of the heart muscle that further reduces the heart ability to pump blood. Electrical disturbances may therefore result in progressive left ventricular dysfunction, due to the added effects of HF-related electrical dyssynchrony. For this reason, device therapy may play a key role in the management of patients with heart failure and reduced ejection fraction (HFrEF). In particular, Implantable Cardioverter- Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) may improve ejection fraction by reestablishing mechanical synchrony, possibly reversing symptoms and signs of heart failure, in addition to the more obvious role of ICD in terminating ventricular arrhythmias that threaten sudden death. Recommendations on device therapy from the current guidelines on heart failure management put out by the ESC/HFA in 2016 update our understanding of the evidence base for the use of ICD and CRT in HFrEF. We review these recommendations and the evidence behind them.

scholarly journals Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators

2020 ◽  
Vol 7 ◽  
Author(s):  
Xiaoyao Li ◽  
Xiaodi Xue ◽  
Xuerong Sun ◽  
Shuang Zhao ◽  
Keping Chen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiac Death ◽  
Hazard Ratio ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Device Implantation ◽  
All Cause Mortality ◽  
Males And Females ◽  
The Impact ◽  
Cardioverter Defibrillators

Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality.Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively.Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA<cut-off values had higher cumulative incidence of cardiac death and all-cause mortality in both males and females. At a PA level between the cut-off values of males and females, males had a higher risk of cardiac death (hazard ratio = 4.952; 95%CI = 1.055-23.245, P = 0.043) and all-cause mortality (hazard ratio = 2.432; 95%CI = 1.095-5.402, P = 0.029).Conclusions: Males had higher predictive PA cut-off values for cardiac death and all-cause mortality in patients with ICD/CRT-D. Sex should be considered as an important contributing factor when deciding for PA targets.

scholarly journals Effects of Covid-19 Lockdown on Patients with Implantable Cardioverter-Defibrillators in South of Italy: possible causes?

2021 ◽  
Author(s):  
Valentino Ducceschi ◽  
Marcello De Vitiis ◽  
Valter Bianchi ◽  
Raimondo Calvanese ◽  
Gregorio Covino ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Medical Personnel ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Campania Region ◽  
Multicentre Cohort Study ◽  
Retrospective Data Collection ◽  
Cardioverter Defibrillators ◽  
Onset Atrial Fibrillation ◽  
Multicentre Cohort

Aims to evaluate the incidence of cardiac arrhythmias during a lockdown period due to COVID-19 pandemics in a population followed by remote monitoring through implanted cardiac defibrillators. Methods and results In this retrospective, multicentre cohort study, we included 574 remotely monitored automatic (AICD) and cardiac resynchronization devices (CRT-D) recipients implanted before January 1st 2019 at seven Hospitals of Campania Region, comparing the incidence of arrhythmias occurred during the lockdown period due to COVID-19 epidemics (from March 9th to May 1st 2020) with the arrhythmias rate of the corresponding period in 2019. An effective retrospective data collection was performed through remote monitoring, as this tool allows the direct transfer of the the information stored by the implantable devices to medical personnel. During the lockdown period, we observed ventricular tachyarrhythmias (ventricular tachycardia or fibrillation) in 25 (4.8%) patients as compared to 12 (2.3%) during the corresponding 2019 period (p < 0.04); new-onset atrial fibrillation was detected in 38 (8.2%) subjects during lockdown period and in 24 (5.2%) during the reference period (p < 0.004). Conclusion During pandemics lockdown period we observed an higher incidence of arrhythmic events in ICD/CRT-D patients followed up through device remote monitoring by seven hospitals of Campania region.

scholarly journals Remote Monitoring with Appropriate Reaction to Alerts Was Associated with Improved Outcomes in Chronic Heart Failure: Results from the OptiLink HF Study

2020 ◽  
Author(s):  
Jan Wintrich ◽  
Valérie Pavlicek ◽  
Johannes Brachmann ◽  
Ralph Bosch ◽  
Christian Butter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Cardiovascular Death ◽  
Medical Intervention ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Decompensation ◽  
Clinical Events ◽  
Improved Outcomes ◽  
Cardioverter Defibrillators

Background - Impedance-based remote monitoring (RM) failed to reduce clinical events in the OptiLink HF trial. However, rates of alert-driven interventions triggered by intrathoracic fluid index threshold crossings (FTC) were low indicating physicians' inappropriate reactions to alerts. Methods - We separated appropriate from inappropriate contacts to FTC transmissions in the OptiLink HF trial. Appropriate contacts had to meet the following criteria: i) initial telephone contact within 2 working days after FTC transmission, ii) follow-up contacts according to study protocol, and iii) medical intervention initiated after FTC due to cardiac decompensation. We compared time to cardiovascular death or heart failure hospitalization between RM patients contacted appropriately or inappropriately and patients with usual care (UC). Results - In the RM group, at least one FTC alert was transmitted in 356 patients (70.5%; n=505). Of note, only 55.5% (n=758) of all transmitted FTCs (n=1365) were followed by an appropriate contact. While 113 patients (31.7%; n=356) have been contacted appropriately after every FTC, in 243 patients (68.3%; n=356) at least one FTC was not responded by an appropriate contact. Compared to UC, RM with appropriate contacts to FTC alerts independently reduced the risk of the primary endpoint (Hazard ratio, 0.61; 95% confidence interval 0.39-0.95; p=0.027). Conclusions - RM appropriate reactions to FTC alerts are associated with significantly improved clinical outcomes in patients with advanced HF and implantable cardioverter-defibrillators.

Implantable Cardiac Devices in the Treatment of Arrhythmias and Congestive Heart Failure

2012 ◽  
Vol 9 (2) ◽  
pp. 99-104
Author(s):  
Soraya M Samii ◽  
Javier E Banchs
Keyword(s):  
Heart Failure ◽  
New Technology ◽  
Standard Of Care ◽  
Cardiac Resynchronization ◽  
Careful Examination ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Devices ◽  
Implantable Cardiac Devices ◽  
Cardioverter Defibrillators ◽  
Improve Patient

The concept of using an implantable device to manage arrhythmias and heart failure started over 50 years ago. Since then, we have seen these devices improve patient outcomes from bradyarrhythmias, atrial fibrillation, ventricular arrhythmias, and heart failure. These devices are now standard of care in the management of patients and include pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) or combination devices. The future may hold expansion of the indications for these devices, with careful examination of the outcomes of today's patients. In addition, there is very exciting new technology that may further advance the management of arrhythmias and heart failure.

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