Failure of Technical Communication in Remote Monitoring of

Cardiac Implantable Electronic Devices

Results of a Long-term Study

Pedro Silva Cunha, Mário Martins Oliveira, Manuel Nogueira da Silva, Joana Feliciano,

Sandra Alves, Ricardo Pimenta, Sofia Almeida Santos and Rui Cruz Ferreira

Santa Marta Hospital, Cardiology Service, Rua de Santa Marta nº 50, 1169-024 Lisboa, Portugal

Keywords: Remote Monitoring, Cardiac Implantable Electronic Devices.

Abstract: Remote monitoring of cardiac implantable electronic devices has been developed for technical control and

follow-up using transtelephonic data transmission methods. In this study we explore the pitfalls of a remote

monitoring program concerning failure of data transmission in a population with implantable cardioverter-

defibrillators.

1 INTRODUCTION

Remote monitoring of cardiac implantable electronic

devices has been developed for technical control and

follow-up using transtelephonic data transmission

methods. This technology allows evaluation of

settings and status of cardiac implantable electronic

devices and the resulting outcome. The remote

monitoring features transmit selected device-related

data to a service-center via a standard phone line or

a mobile phone network. In case of a potential

emergency situation, event reports are generated

automatically according to the selected setting for

alarms notification. It has been proven to be

technically reliable, allowing early identification of

device malfunction and arrhythmic events, and

minimizing the risk of under-reporting. This remote

interrogation can be used for scheduled and

unscheduled technical and patient monitoring and

follow-up. However, there is lack of data regarding

technical problems related with failure of

communication and data transmission.

2 AIM

To explore the pitfalls of a long-term remote

monitoring program regarding data transmission in a

population with an implantable cardioverter-

defibrillator (ICD).

3 METHODS

We reviewed the data from two hundred and sixty

patients (74% men; 60.4±14.6 years) with an ICD

(n=190; 21% dual-chamber) or an ICD combined

with a cardiac resynchronization therapy device

(n=70).

Cardiac implantable electronic devices were

implanted for primary prevention of sudden death in

160 cases and for secondary prevention in 100 cases.

The cardiac implantable electronic devices and

remote monitoring systems manufacturer´s were

Biotronik (n=95), Medtronic (n=92); Boston

Scientific (n=62) and Sorin (n=8).

Data was incorporated into the hospital

information system via web and analyzed by an

allied professional and an electrophysiologist in a

single center follow-up program. The transmitter

will only send the data according to scheduled time

intervals or if requested by the patient or health-care

professional (non-scheduled transmission). Patients

were included in the study if they were followed-up

for a period longer than 6 months. We considered

data of all transmissions, including communication

concerning cardiac implantable electronic devices

and the transmitter, communication amongst the

transmitter and the manufacturer’s remote

monitoring data centre, and communication between

the manufacturer’s data centre and the hospital. The

data could be sent to the manufacturer’s remote

monitoring data centre by the conventional

Silva Cunha P., Martins Oliveira M., Nogueira da Silva M., Feliciano J., Alves S., Pimenta R., Almeida Santos S. and Ferreira R..

Failure of Technical Communication in Remote Monitoring of Cardiac Implantable Electronic Devices - Results of a Long-term Study.

 2013 SCITEPRESS (Science and Technology Publications, Lda.)

telephone cable network often called a ‘landline’ or

by a digital cellular phone technology. All

communication between the transmitter and the

manufacturer’s data centre were encrypted to

guarantee patient privacy and safety.

4 RESULTS

After a mean follow-up of 34±18 months, there were

alert messages in 60 patients (range from 1 to 234

per patient) resulting in a response from the health-

care team (<48 hours period of time).

In the majority of cases (83%) the information

was due to ventricular tachyarrhythmia (n=24) or

atrial fibrillation (n=26) episodes. Failure of data

transmission occurred in 9 patients (3,4%),

distributed by all device companies, and were due

to: reduced signal strength of landline phone in the

coverage area (n=2), repeated local energy failure

(n=1), travelling abroad (n=2), technical problems

with the transmitter (n=3), unknown (n=1).

After identification of the type of difficulty the

transmission problems were solved after new

instructions for the management of the transmitter or

changing of the communication equipment in 3 of

the cases.

5 CONCLUSIONS

Remote monitoring systems may represent an

advantage in the complex follow-up of cardiac

implantable electronic devices. However, in a long-

term period, there are a few cases in which data

transmission failed due to technical communication

problems.

REFERENCES

Morichelli L., Ricci R. P.: Remote monitoring of

implantable devices: the European experience. Heart

Rhythm. 2009;6(7):1077–80).

Maisel W. H., Kohno T. Improving the security and

privacy of implantable medical devices. N Engl J

Med. 2010;362(13):1164–1166).

Dubner, S. et al., 2012. ISHNE/EHRA expert consensus

on remote monitoring of cardiovascular implantable

electronic devices (CIEDs). Europace, 14(2), pp.278-

293.