Remote monitoring of implantable cardioverter defibrillator patients: a safe, time-saving, and cost-effective means for follow-up.

AIMS: The purpose of this prospective study was to investigate whether internet-based remote monitoring offers a safe, practical, and cost-effective alternative to the in-office follow-up visits of patients with an implantable cardioverter defibrillator (ICD). METHODS AND RESULTS: Forty-one patients (62 +/- 10 years, range 41-76, 83% male) with previously implanted ICD were followed for 9 months. One-hundred and nineteen scheduled and 18 unscheduled data transmissions were performed. There were no device-related adverse events. Over 90% of the patients found the system easy to use. Physicians reported the system as being 'very easy' or 'easy' to use and found the data comparable to traditional device interrogation in 99% of the cases. They were able to address all unscheduled data transmissions remotely. Compared with the in-office visits, remote monitoring required less time from patients (6.9 +/- 5.0 vs. 182 +/- 148 min, P < 0.001) and physicians (8.4 +/- 4.5 vs. 25.8 +/- 17.0 min, P < 0.001) to complete the follow-up. Substitution of two routine in-office visits during the study by remote monitoring reduced the overall cost of routine ICD follow-up by 524 euro per patient (41%). CONCLUSION: Remote monitoring offers a safe, feasible, time-saving, and cost-effective solution to ICD follow-up.

Quality of life restored to normal in patients with atrial fibrillation after pulmonary vein ostial isolation.

BACKGROUND: Pulmonary vein isolation (PVI) is effective in patients with paroxysmal atrial fibrillation. However, its impact on quality of life (QOL) is not completely understood. METHODS: Eighty-nine otherwise healthy patients (74 men; age, 53 +/- 11 years) were selected for PVI. The Medical Outcomes Short Form 36 (SF-36) and the Symptom Checklist (SCL) QOL questionnaires were obtained before PVI and for as long as 6 months after PVI. RESULTS: A total of 294 PVs (3.3 PVs/patient) were targeted in 125 procedures (1.4/patient). After a mean follow-up period of 191 +/- 109 days, scores for SCL frequency (19.09 +/- 8.07 vs 10.67 +/- 6.61), SCL severity (15.97 +/- 7.68 vs 9.72 +/- 5.98), SF-36 physical composite (45.43 +/- 9.70 vs 51.70 +/- 6.52), and SF-36 mental composite (44.50 +/- 11.33 vs 51.67 +/- 8.73) improved significantly (P <.0001 each). Seventy-five patients provided data at both the baseline and a late (3- or 6-month) follow-up. This cohort had significantly worse QOL scores in 7 of the 8 SF-36 subscales at baseline compared with age-matched healthy control subjects, but their QOL scores were similar to a comparison group of 152 previously reported patients with atrial fibrillation receiving drug treatment who had similar demographic and clinical variables. After PVI, patients improved significantly, resulting in equivalence with the healthy control population. Logistic regression analysis of demographic variables and baseline QOL scores revealed no significant predictors of PVI responders. CONCLUSIONS: QOL measures in patients with paroxysmal atrial fibrillation are severely depressed before PVI. Within a 6-month follow-up period after ablation, SF-36 subscale scores were restored to equivalence with an age-matched, healthy control population. Neither demographic or clinical variables nor baseline QOL scores were predictive of response to PVI.