HOME MONITORING OF IMPLANTED ANTIARRHYTHMIC DEVICES IN CONTROL OF EFFECTIVENESS OF THERAPY OF CHRONIC HEART FAILURE

To assess effectiveness of control over therapy of chronic heart failure (CHF) using the technique of home monitoring of implanted antiarrhythmic devices, 50 patients aged 63±7 years were examined. The patients were hospitalized in a planned manner due to the following indications: 13 patients (26%) with the sick sinus syndrome, 15 patients (30%) with the third degree atrio-ventricular block, 18 subjects (36%) with bradycardia-tachycardia syndrome, and 4 ones (8%) with ventricular tachycardia/fibrillation. All subjects had chronic heart failure; CHF II (NYHA classification) in 21 patients (42%), CHF III in 23 patients (46%), and CHF IV in 6 patients (12%). The following devices with the home monitoring function were implanted to the study subjects: Evia DR to 40 patients (80%) and Lumax DR to 10 patients (20%). The patients received the background therapy of the underlying disease with additional medical treatment of CHF; 2 patients (4%) received the therapy with angiotensin converting enzyme inhibitors (ACEI); 12 patients (24%), ACEI and diuretics; 29 patients (58%), ACEI, diuretics, and β adrenoblockers; and 7 patients (14%), ACEI, diuretics, and nitrates. Within 10±3 months, the following parameters recorded by implanted antiarrhythmic devices were recorded: pacing threshold, impedance (including that on shock electrode), part of spontaneous and stimulated events, the atrial fibrillation burden, and the physical activity sensed by the device. Besides, the patient telephone questioning was carried out for subjective assessment of symptoms and the CHF deterioration/improvement. During the follow-up period, 12 patients (24%) dropped out from the study due to inacceptable treatment compliance. In other patients, mean functional class of CHF decreased from 2.68±0.68 to 2.26±0.92 (p<0.00006). The correlation of the CHF functional class with pacing threshold was r=-0.2, p>0.05; with impedance on the shock electrode, r=-0.63, p=0.051; with the portion of spontaneous complexes, r=0.08, p>0.05; with the AF burden, r=-0.3, p>0.05; and with the physical activity detected by the device sensor, r=0.69, p<0.05. The visual analysis of graphs of the parameters studied, especially of the level of the subjects’ physical activity sensed by the implanted antiarrhythmic device, was the most informative method of remote assessment of general well-being. The data obtained also correspond to those of the TRUST, COMPAS, and REFORM studies which showed a decreased number of the subjects’ visits to the hospital by 45%, 55%, and 63%, respectively. Thus, the technique of home monitoring of implanted antiarrhythmic devices can be successfully used for control of effectiveness of the CHF treatment, even in absence of the thoracic impedance sensors. The parameters with the greatest informational value are the shock electrode impedance, the physical activity sensed by the device, as well as the visual analysis of the graphs.

chronic heart failure, cardiac pacemaker, implanted cardioverter-defibrillator, cardiac resynchronization therapy, home monitoring

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