Objectives: The purpose of this study was to evaluate remote pacemaker interrogation for the earlier diagnosis of clinically actionable events compared with traditional transtelephonic monitoring and routine in-person evaluation. Background: Pacemaker patient follow-up procedures have evolved from evaluating devices with little programmability and diagnostic information solely in person to transtelephonic rhythm strip recordings that allow monitoring of basic device function. More recently developed remote monitoring technology leverages expanded device capabilities, augmenting traditional transtelephonic monitoring to evaluate patients via full device interrogation. Methods: The time to first diagnosis of a clinically actionable event was compared in patients who were followed by remote interrogation (Remote) and those who were followed per standard of care with office visits augmented by transtelephonic monitoring (Control). Patients were randomized 2:1. Remote arm patients transmitted pacemaker information at 3-month intervals. Control arm patients with a single-chamber pacemaker transmitted at 2-month intervals. Control arm patients with dual-chamber devices transmitted at 2-month intervals with an office visit at 6 months. All patients were seen in office at 12 months. Results: The mean time to first diagnosis of clinically actionable events was earlier in the Remote arm (5.7 months) than in the Control arm (7.7 months). Three (2%) of the 190 events in the Control arm and 446 (66%) of 676 events in the Remote arm were identified remotely. Conclusions: The strategic use of remote pacemaker interrogation follow-up detects actionable events that are potentially important more quickly and more frequently than transtelephonic rhythm strip recordings. The use of transtelephonic rhythm strips for pacemaker follow-up is of little value except for battery status determinations. (PREFER [Pacemaker Remote Follow-up Evaluation and Review]; NCT00294645).
Bibliographical noteFunding Information:
A list of the PREFER investigators can be found in the Online Appendix . This study was supported by Medtronic Inc., Minneapolis, Minnesota. Dr. Crossley is on the advisory board for Medtronic and receives income from research and lecturing for Medtronic, and receives research support from Boston Scientific and St. Jude Medical. Dr. Chen receives honoraria and fellowship support from Medtronic. Dr. Cohen receives honoraria from Medtronic. Drs. Johnson and Serwer serve as consultants for Medtronic. Dr. Mongeon and Ms. Qiao are employees of Medtronic and hold Medtronic stock. Dr. Wilkoff receives honoraria for being a consultant and a physician advisory committee member, receives royalty payments for a patent from Medtronic, and receives research support from Medtronic.
- remote follow-up