| Objective:This study aims to explore the role of Home Monitoring system for patients with congestive heart failure after CRT-D implantationMETHODS:We reviewed the patients with CRT-D equipped Home Monitoring system in Fuwai Hospital from June2010to October2011. The data of patients were transmitted to the manufacturers by Home Monitoring system, and forward to the doctors. All patients were schedualed to return to hospital in1,3,6and12months regularly after CRT-D implantation. If cardiovascular events happened, patients were required to contact with the doctor and return to the hospital for examination and treatment. In this study, we observed the proportion CRT-D biventricular pacing;24-hour average heart rate; ventricular arrhythmia rate and CRT-D treated as well as doctor's reaction time.RESULTS:We reviewed a total of13patients in the Fu Wai Hospital (mean age64.5±9.68year,69.2%male). After an average of16months follow-up period,25 times heart failure aggravation of nine patients were reported to the doctor. Seven patients hospitalized11times due to heart failure.1patients died in the second hospitalization because of worsening heart failure. The average percentage of bi-ventricular pacing was96.7%,24h average heart rate was86.7±14.3bpm.. The patient's24hours average heart rate tended to increase in the week before admission.256ventricular arrhythmia events of six patients were recorded:included225VT and31VF.21(9.3%) of VT and VF (19.3%) were mis-detecton.12shock were delivered.3inappropriated shock were delivered due to atrial fibrillation with fast ventricular rate in1patient. Compared with the conventional three months follow-up interval, Home Monitoring system provied46.4±21.3days reaction time to doctors.Conclusion:Home Monitoring system can effectively monitor changes in condition of patients with heart failure. And Home Monitoring system can transmitted the imformations of HF aggravation, VT/VF episodes, and device disfunction earlier than tranditional follow-up, provides more reaction time to clinicians. Background:The Medtronic InSync Sentry is the first available CRT-D with automatic fluid status monitoring via measuring intrathoracic impedance.Objective:This study was designed to observe the effectiveness of intrathoracic impedance monitoring on detecting aggravation in chronic heart failure patients. If intrathoracic impedance persistently decreases and has reached the programmed alert threshold, the device will give an audible alarm.Methods:We retrospectively analyzed the clinical data of36consecutive patients. Patients were regularly followed up at1,3,6,12months after the implantation. At each visit, interrogation of the device was done by specified doctors. Patients were instructed to inform the researcher in case of a device alert, and to take extra40milligrams of furosemidum if they really had aggravated symptoms later. If the symptoms couldn't be relieved by40milligrams of furosemidum, they were asked to see a doctor. Data about heart failure hospitalization was collected retrospectively from the medical record.Results: During7-48months follow-up, a total of16patients encountered75alert events. On one hand, alert events appeared before all deteriorated symptoms and heart failure hospitalizations. On the other hand, there were44(58.6%) alerts followed by deterioration of heart failure symptoms, and2(7.1%) alerts related to2hospitalizations caused by pulmonary infection rather than heart failure deterioration in one patient. Patient with OptiVol Alert showed lower LVEF at6month after implantation.Conclusions:The function of intrathoracic impedance monitoring can predict cardiac function de-compensation with satisfying specificity and sensitivity. Intervention immediately after an alert event may prevent acute aggravation of heart failure to the greatest extent.
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