br Components of a remote monitoring system The

Components of a remote monitoring system The components constituting a remote monitoring system [27] consist of:
Which parameters to monitor? The above is an overview of the currently available sensors for CRT. As can be seen from previous studies, not all of these sensors will lead to favorable clinical outcomes. For example, the DOT-HF trial [42], which involved monitoring of intra-thoracic impedance by OptiVol™ (an electrical parameter), showed a possible wastage of healthcare resources by increasing the rate of hospitalization and in-office visits by up to three times, without conferring any benefit in terms of mortality. Interestingly, trials that aimed to detect hemodynamic parameters (whose changes occur earlier on in the course of HF) showed a significant decrease in hospital admissions and mortality: e.g., the HOMEOSTASIS (LA pressure sensor) [33] and CHAMPION (wireless PA pressure sensor) [34] trials. A trend can be seen, where the detection of hemodynamic parameters may have a more positive impact in reducing future hospitalizations due to HF, as these hemodynamic changes occur earlier in the stages leading to HF decompensation. Only beyond a critical RV pressure would intrathoracic impedance begin to increase. Therefore, parameters that reflect late changes in decompensated HF, i.e., pulmonary congestion, will not be as effective, as they will not allow so much time for earlier medical intervention.
Future trends Researchers are investigating ways to optimize the limited sensitivity and specificity of current HF sensors by using a combination of sensors to predict HF events. In the Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients with Heart Failure (PARTNERS HF) study, researchers achieved an improved predictive value for acute decompensated HF by utilizing multiple arrhythmic and pgi2 parameters, including atrial fibrillation with a long duration and rapid ventricular rate, an increase in Optivol fluid index, low patient activity, and abnormal autonomic tone [45]. Another study that combined RV pressure and intrathoracic impedance monitoring also showed improved accuracy [50]. Future directions in the field of sensor technology lean towards the miniaturization of sensors and possible biologic energy-capturing technology to minimize battery consumption.
Conclusion
Conflict of interest
Introduction Over the last few decades there has been a significant increase in the number of patients receiving cardiovascular electronic implantable cardiac devices [1,2]. This was the result of large body of evidence showing the important role of these devices in improving both the quality of life and survival among patients with heart disease [3,4]. In the United States, it is estimated that about 4.2 million patients underwent implantation of a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) between 1993 and 2008 [5]. With an increasingly aging population, more CIEDs are implanted in older patients with more comorbidities [6]. With this growth in number of CIED implantation has come and increasing recognition of associated complications. One of these complications is CIED infection, and while its incidence remains low, the significant morbidity and mortality associated with this complication makes it one of the most serious complications of CIED implantation [7].
The magnitude of the problem There has been a wide range of reported rates of CIED infection in the literature. The lack of a clear denominator, the inconsistency in defining CIED infection, and the different follow up durations used, make the understanding of the true incidence of CIED infection challenging. In general, it is believed that the risk of CIED infection after de-novo primary implantation is about 0.5% and is higher for device replacement or upgrade at around 1–7% [8–11]. While the incidence rate of CIED infection remains low, the rate of increase in reported CIED infections each year is alarming [12,5,13].