Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery

Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs). A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences). As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients. 1. Introduction In the last decades, the advances in information and communication technology have permitted that telehealth supports are diffusing rapidly into all aspects of healthcare. Integration of traditional medical practices with computerized supports and Internet functionalities may improve quality of life and solve problems of access health disparities for some patient categories [1–3]. Home-care is a term often used to describe telemedicine applications in which medical services are delivered to patients at their homes. Home-care is especially important for a specific group of patients with long-term chronic conditions, such as chronic cardiac diseases. Recently, there is a growing interest also in the remote monitoring and followup of implantable cardioverter defibrillators (ICDs). The number of patients with implantable devices has been growing steadily, mainly because indications for ICD shifted from secondary to primary prevention of sudden death [4] (for more details refer to Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) [5]). According to current guidelines (issued by AHA, ACC, etc.), patients with an ICD should be followed up every 3–6 months (increasing frequency as the battery approaches elective replacement) to ensure proper device function. However,