New Technologies in Cardiology

Address for correspondence: Dr med. Michał Chudzik, Department of Cardiology, 1 Chair of Cardiology and Cardiosurgery, Medical University of Łódź, Sterlinga 1/3, 91–425 Łódź, Poland, tel./fax: +48 42 636 44 71, e-mail: [email protected] The clinical use of implantable cardioverter defibrillators (ICDs) has increased rapidly since the results of several randomized trials confirmed the efficacy of ICDs in the secondary and primary prevention of sudden cardiac death [1]. The more complex devices are leading to a rapidly increasing workload for the follow-up of these patients in specialized centres. According to international guidelines, ICD patients should be followed at intervals of between one and four months, depending on the ICD model and clinical status [2]. Increasing numbers of follow-ups for ICD patients are among the main problems for healthcare systems worldwide. Recent advances in wireless communication, data storage and implantable electronic technologies have ushered in a new era of real-time, remote electrocardiographic monitoring using implantable devices [3]. Many studies have shown the ability of remote monitoring to reduce follow-up in patients with ICD, to detect serious ICD defects and to check on a patient’s daily clinical condition [4–7]. One of the first remote follow-up options for patients with an ICD is Home Monitoring by Biotronik, a revolutionary system that allows a defibrillator to connect to the cellphone network in such a way that it can communicate directly with the physician. Home Monitoring works with a small device called the CardioMessenger (CM), about the size of a large cellphone. CM communicates via the world cellphone network (GPRS network). The ICD contains a built-in antenna that periodically dispatches reports on the patient’s heart and the functioning of the device. The CM picks up these signals and forwards them to a service center, which processes the information and posts it on a secure website for review by the doctor. Urgent matters can go directly to physicians by fax, email, SMS and telephone. The physician can review the Home Monitoring reports and if anything is wrong, he or she will call the patient to make an appointment (Fig. 1). Biotronik’s Home Monitoring system is at the moment the only one which can act completely automatically. Unlike all other telemonitoring systems, all information from the patient’s device to the doctor is sent without the patient having to do anything. Home Monitoring keeps the doctor informed as to what is going on with the heart and the implanted device. The objective is to make data available for: — diagnosis of the arrhythmia with internal electrogram (IEGM) available on line; — monitoring of the patient’s status; — analysis of the effectiveness of therapies delivered by the implant;