Remote patient management using implantable devices.

Remote patient management utilizing the Internet is a milestone in the management of patients with an implantable cardiac device. Pacemakers and implantable cardioverter-defibrillators (ICDs) store diagnostic information about device and lead integrity, the occurrence of atrial and ventricular arrhythmias, and parameters that may reflect on a patient's heart failure status. Previously, these data could only be retrieved with a programmer at an in-person office visit. The introduction of remote follow-up and monitoring has changed the paradigm for the management of patients with implanted devices. Remote follow-up has been shown to be superior to traditional transtelephonic monitoring for the detection of clinically actionable events in pacemaker patients. Remote monitoring using ICDs with wireless technology has been demonstrated to result in detection of lead malfunction and atrial and ventricular arrhythmias while reducing the need for in-office evaluations without compromising patient safety. Studies are underway to evaluate the clinical utility of identification of atrial high-rate episodes and to identify patients at risk for exacerbation of heart failure. Remote monitoring technology has yet to be universally adopted by patients or physicians. Impediments to the implementation of remote monitoring including issues related to work flow and data management are explored.