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Schrittmacher und interne Defibrillatoren mit kardiotelemedizinischer Unterstützung

Pacemaker and implantable defibrillators with telemedical support

  • Leitthema: Telemedizin
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die Entwicklungen in der Herzschrittmacher- und ICD-Therapie in den letzten Jahren sind durch steigende Implantationszahlen (insbesondere bei ICD- und CRT-Systemen) und eine zunehmende Komplexität der Aggregate gekennzeichnet. Probleme ergeben sich aus der großen Anzahl notwendiger Nachkontrollen sowie in Bezug auf die Patientensicherheit und das Device-Management durch spezialisierte Ärzte. Die telemedizinische Überwachung kann hier Lösungsansätze bieten. Die Hersteller haben praxistaugliche Systemlösungen für das Telemonitoring von Patienten mit Herzschrittmachern, ICDs und CRT-Systemen entwickelt. Die Systeme bestehen aus dem Implantat mit automatischer oder manueller Datenübertragung, einem Patientenmonitor mit Datenübertragung (Mobilfunk, Festnetz), dem Datenserver und der Datenpräsentation (Internetplattform) für den Arzt. In verschiedenen klinischen Studien wurde die Stabilität und Sicherheit der Datenübertragung nachgewiesen. Durch das telemedizinische Monitoring kann die Überwachung der Patienten (z. B. Patienten mit CRT-Systemen wegen chronischer Herzinsuffizienz) und das Arrhythmie-Management (z. B. bei Patienten mit paroxysmalem Vorhofflimmern) verbessert werden. Das Telemonitoring macht auch eine Individualisierung der Nachkontrollintervalle möglich, was zu einer Kostenersparnis führt. Die telemedizinische Überwachung von Patienten mit ICD- und CRT-Systemen eröffnet neue Möglichkeiten zur vernetzten Nachsorge und umfassenden medizinischen Betreuung.

Abstract

Recent developments in pacemaker and ICD therapy can be characterized by a rising number of implantations (especially in the field of ICD and CRT systems) and an increasing complexity of the units involved. Problems evolving from this trend are the soaring numbers of necessary follow-up examinations, issues of patient safety and the necessity of device management by specialized physicians. Telemonitoring offers various possibilities of improvement in these areas. The manufacturers of the devices have developed applicable solutions for concepts of care including telemedical monitoring of patients with pacemakers, ICD and CRT systems. The systems commonly include an implant capable of either automatic or manual data transmission, a device for transmitting the implant's data (mobile communication or fixed line network), a server managing the information and a front-end (internet-based) platform for the physician. Multiple clinical trials have verified the stability and the security of this method of data transmission. Telemedical monitoring can be used in order to improve the monitoring of the patients' state of health (e. g., patients with CRT systems because of their CHF) and the management of arrhythmias (e. g., patients suffering from paroxysmal atrial fibrillation). Telemonitoring allows the intervals between follow-up check-ups to be individualized, thus, leading to financial savings. The telemedical monitoring of patients with ICD and CRT systems facilitates new opportunities for networked follow-up care and comprehensive medical treatment.

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Literatur

  1. Moss AJ, Zareba W, Hall WJ, et al. (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883

    Article  PubMed  Google Scholar 

  2. Bristow MR, Saxon LA, Boehmer J, et al.; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150

    Article  PubMed  CAS  Google Scholar 

  3. Lemke B, Nowak B, Pfeiffer D (2005) Leitlinien zur Herzschrittmachertherapie. Z Kardiol 94:704–720

    Article  PubMed  CAS  Google Scholar 

  4. Jung W, Andresen D, Block M, et al. (2006) Leitlinien zur Implantation von Defibrillatoren. Clin Res Cardiol 95:696–708

    Article  PubMed  CAS  Google Scholar 

  5. Epstein AE, DiMarco JP, Ellenbogen KA, et al. (2008) ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol 51:2085–2105

    Article  Google Scholar 

  6. Zhan C, Baine WB, Sedrakyan A, Steiner C (2007) Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis. J Gen Intern Med 23(Suppl 1):13–19

    Article  Google Scholar 

  7. Alter P, Waldhans S, Plachta E, et al. (2005) Complications of implantable cardioverter defibrillator therapy in 440 consecutive patients. PACE 28:926–932

    PubMed  Google Scholar 

  8. Maisel WH, Moynahan M, Zuckerman BD, et al. (2006) Pacemaker and ICD generator malfunctions. Analysis of Food and Drug Administration Annual Reports. JAMA 295:1901–1906

    Article  PubMed  CAS  Google Scholar 

  9. Schwab JO, Müller A, Oeff M, et al. (2008) Telemedizin in der Kardiologie – Relevanz für die Praxis!? Herz 33:420–430

    Article  PubMed  Google Scholar 

  10. Dreifus LS, Zinberg A, Hurzeler P, et al. (1986) Transtelephonic monitoring of 25,919 implanted pacemakers. PACE 9:371–378

    PubMed  CAS  Google Scholar 

  11. Maines M, Catanzariti D, Cemin C, et al. (2007) Usefulness of intrathoracic fluids accumulation monitoring with an implantable biventricular defibrillator in reducing hospitalizations in patients with heart failure: a case-control study. J Interv Card Electrophysiol 19:201–207

    Article  PubMed  Google Scholar 

  12. Landolina M, Lunati M, Vergara G, et al. (2008) Intrathoracic impedance monitored with an implantable biventricular defibrillator reduces hospitalizations in patients with heart failure. Eur J Heart Failure Suppl 7(Suppl 1):169

    Article  Google Scholar 

  13. Wallbrück K, Stellbrink C, Santini M, et al. (2002) The value of permanent follow-up of implantable pacemakers – first result of an European trial. Biomed Technik 47:950–953

    Article  Google Scholar 

  14. Varma N, Stambler B, Chun S (2005) Detection of atrial fibrillation by implanted devices with wireless data transmission capability. PACE 28:S133–S136

    PubMed  Google Scholar 

  15. Lazarus A (2007) Remote, wireless, ambulatory monitoring of implantable pacemakers, cardioverter defibrillators, and cardiac resynchronization therapy systems: analysis of a worldwide database. PACE 30:S2–S12

    PubMed  Google Scholar 

  16. Scholten MF, Thornton S, Theuns DA, et al. (2004) Twiddler's syndrome detected by home monitoring device. PACE 27:1151–1152

    PubMed  Google Scholar 

  17. Ritter O, Bauer WR (2006) Use of „IEGM Online“ in ICD patients – early detection of inappropriate classified ventricular tachycardia via Home Monitoring. Clin Res Cardiol 95:368–372

    Article  PubMed  Google Scholar 

  18. Res JCJ, Theuns DAMJ, Jordaens L (2006) The role of remote monitoring in the reduction of inappropriate implantable cardioverter defibrillator therapies. Clin Res Cardiol 95(Suppl 3):III/17–III/21

    Article  Google Scholar 

  19. Perings C, Klein G, Toft E, et al. on behalf of the RIONI Investigators (2006) The RIONI study rationale and design: validation of the first stored electrograms transmitted via home monitoring in patients with implantable defibrillators. Europace 8:288–292

    Article  PubMed  CAS  Google Scholar 

  20. Schoenfeld MH, Compton SJ, Mead RH, et al. (2004) Remote monitoring of implantable cardioverter defibrillators: a prospective analysis. PACE 27:757–763

    PubMed  Google Scholar 

  21. Nielsen JC, Kottkamp H, Zabel M, et al. (2008) Automatic home monitoring of implantable cardioverter defibrillators. Europace 10:729–735

    Article  PubMed  Google Scholar 

  22. Brugada P (2006) What evidence do we have to replace in-hospital implantable cardioverter follow-up ? Clin Res Cardiol 95(Suppl 3):III/3–III/9

    Article  Google Scholar 

  23. Heidbüchel H, Lioen P, Foulon S, et al. (2008) Potential role of remote monitoring for scheduled and unscheduled evaluations of patients with an implantable defibrillator. Europace 10:351–357

    Article  PubMed  Google Scholar 

  24. Stellbrink C, Trappe H-J (2007) The follow-up of cardiac devices: what to expect for the future? Eur Heart J Suppl 9(Suppl I):I113–I115

    Article  Google Scholar 

  25. 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. Am Heart J 154:1029–1034

    Article  PubMed  Google Scholar 

  26. Ellery S, Pakrashi T, Paul V, Sack S on behalf of the Home CARE Phase 0 Study Investigators (2006) Predicting mortality and rehospitalization in heart failure patients with home monitoring – The Home CARE pilot study. Clin Res Cardiol 95(Suppl 3):III/29–III/35

    Article  Google Scholar 

  27. Ricci RP, 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 10:164–170

    Article  PubMed  Google Scholar 

  28. Perings SM, Bläse I, Marx R, et al. (2008) Register zur verzahnten Nachsorge von ICD-Patienten durch Home-Monitoring: Erfahrungen mit den ersten Patienten im 1-Jahres-Follow-up. J Kardiol 15:17–22

    Google Scholar 

  29. Hindricks G, Bauer WR, Schwab JO, et al. (2008) Was bringt die Telekardiologie für Arzt und Patient? Dtsch Ärztebl 105:B141–B144

    Google Scholar 

  30. Fauchier L, Sadoul N, Kouakam C, et al. (2005) Potential cost savings by telemedicine-assisted long-term care of implantable cardioverter defibrillators recipients. PACE 28:S255–S259

    PubMed  Google Scholar 

  31. Raatikainen MJP, Uusimaa P, van Ginneken MME, et al. (2008) Remote monitoring of implantable cardioverter defibrillator patients: a safe, timesaving, and cost-effective means for follow-up. Europace 10:1145–1151

    Article  PubMed  Google Scholar 

  32. Rotman B, Perl S, Pieske B, et al. (2008) Integriertes Therapiemanagement auf Basis der H.ELGA (Herzschrittmacher. Elektronische Gesundheitsakte). http://www.ehealth2008.at/program/presentations/Session1_MedizinischeInformationssysteme/2_rotman-kollmann.pdf

  33. Piniewski B, Fisher JE, Mansfield JG (2008) Connected Personal Health in 2015: Getting it Right! http://www.continuaalliance.org

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Authors and Affiliations

  1. Klinikum Chemnitz GmbH, Chemnitz, BRD

    Axel Müller & J. Schweizer

  2. Deutsche Stiftung für chronisch Kranke, Fürth, BRD

    T. M. Helms

  3. Klinikum Kassel GmbH, Kassel, BRD

    J. Neuzner

  4. Vitaphone GmbH, Mannheim, BRD

    H. Korb

  5. Klinik für Innere Medizin I der Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, BRD

    Axel Müller

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  1. Axel Müller
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  2. T. M. Helms
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  4. J. Schweizer
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  5. H. Korb
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Correspondence to Axel Müller.

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Müller, A., Helms, T.M., Neuzner, J. et al. Schrittmacher und interne Defibrillatoren mit kardiotelemedizinischer Unterstützung. Bundesgesundheitsbl. 52, 306–315 (2009). https://doi.org/10.1007/s00103-009-0793-9

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  • DOI: https://doi.org/10.1007/s00103-009-0793-9

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