OPTIMIZATION OF ACTIVITIES OF FEDERAL CENTER OF CARDIVASCULAR SURGERY USING THE SYSTEM OF REMOTE MONITORING IN PATIENTS WITH IMPLANTED ANTIARRHYTHMIC DEVICES

To study potentialities of remote monitoring systems in patients with implanted antiarrhythmic devices, 49 patients (including 40 men) managed in Federal Center of Cardiovascular Surgery and connected to the Carelink system were studied. Cardioverters-defibrillators (ICD) were implanted to 12 patients; cardiac resynchronization therapy defibrillators (CRT-D), to 37 patients. The study subjects aged 50 60 years (mean: 53 years); the left ventricular ejection fraction was 27 36% (mean: 32%). Dilated cardiomyopathy was documented in 30 subjects (61%), ischemic cardiomyopathy was found in 19 patients (39%). A history of cardiovascular surgical interventions were documented in 12 patients (25%). Within the analyzed period of time (on 20 August 2013 through 30 September 2014), 497 transmissions were carried out (10 transmissions per patient, on the average), 10% of them were related to transmissions with events, which were high priority unexpected ones. Approximately in one fourth of study subjects, anxiety about potential fluid retention was revealed which coincided with their hospitalization due to clinical deterioration of chronic heart failure (CHF). The authors suggest that frequent sustained paroxysms of atrial fibrillation (AF), a decreased burden of biventricular pacing, and discontinuation of medical treatment are major causes of an increased OptiVol index. 403 episodes of ventricular arrhythmia were detected, as follows: 25 events in the area of ventricular fibrillation - ventricular fibrillation was detected in 7 patients; 330 events in the area of ventricular tachycardia (VT) - ventricular tachycardia was detected in 7 patients; and 48 events in the area of fast VT - fast VT was detected in 2 subjects). In 78% of cases (315 events), the implanted device attempted to terminate tachycardia by antitachycarditic pacing (ATP) with the success rate of 85%. The tachycardia termination using ATP occurred mostly in patients with VT and fast VT. In 11% of documented ventricular arrhythmias (46 events), ICD applied shocks which restored the sinus rhythm in 76% of cases. In the overwhelming majority of cases, ICD shocks were related to detection of events in the ventricular fibrillation area (75%). Approximately 60% of ICD shocks were submaximal ones (lower than 35 J). Other paroxysms terminated spontaneously. Grace to the results of remote monitoring, the procedure of radiofrequency ablation for arrhythmia registered for the first time by the implanted device was performed in 6 patients. Thus, the active implementation of systems of remote monitoring of patients with implanted antiarrhythmic devices is of a high priority especially in big centers/departments for surgical treatment of arrhythmia and is an important tool for optimization of their activities and improvement of their quality.

remote monitoring, cardiac pacemaker, cardioverter-defibrillator, cardiac resynchronization therapy, chronic heart failure, cardiac arrhythmia

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