Biomedical Engineering Reference
In-Depth Information
13.2.1 Home Monitoring TM (Biotronik, Germany)
certain pacing and defibrillation systems may allow repro-
gramming both to unipolar and bipolar configurations, as
well as to an extended bipolar configuration with the use of
the proximal electrode of the right ventricular lead.
Biotronik is a pioneering company in the field of remote
pacemaker/ICD monitoring; the company started its opera-
tion in 2001. The CardioMessenger® patient unit is only
slightly larger in size than a mobile phone and is capable of
wireless communication with an implanted device within
2 m. The patient unit forwards obtained data to the manage-
ment center using a GSM network; this is the main advantage
of the system because mobile phone connections are more
common than traditional dial-up connections today. This also
means that a patient is monitored at all times; he or she can
take the CardioMessenger device anywhere and is able to
recharge it. The system is compatible with most available
GSM networks. Reporting parameters may be set on a secured
web site, which makes a visit to the physician unnecessary.
Intracardial ECG records 30 s long are sent for the purpose of
evaluation. Regular measurements are sent once a day at a
preprogrammed hour set by the physician at a routine follow-
up using a programming device supplied by the manufacturer.
It is convenient to set an hour at night, while the patient is
asleep and the patient unit is on the bedside table [89].
Currently, this system is the only system to offer monitoring
of pacemakers, too, that is, it does not monitor only ICDs.
13.2
Remote Patient Monitoring
First, it must be noted that the idea of remotely monitoring
implanted devices is not novel. As early as at the beginning of
1970s, a concept of pacemaker longevity, transtelephonic mon-
itoring (TTM), was introduced [85]. At the turn of the 1980s, the
diagnostic features of the TTM system were extended by addi-
tional functions, including the sensing of intrinsic potentials,
pacing successfulness, lead defects, and arrhythmias [ 86, 87 ] .
Nevertheless, TTM pacemakers, commonly used in the
USA, did not become massively popular in Europe. This method
also required active cooperation on the part of the patient, which
prevented mass spread of the use of this pacemaker [88].
At present, four systems operate or are about to be intro-
duced globally. The launch has been delayed because of leg-
islative issues concerning the protection of patient data or the
use of a frequency spectrum. All systems work on a similar
principle of a patient unit, communicating with an implanted
device by means of various technical methods, and central
data administration, that is, a telephonic or control computer
center on a global or national level.
An implanted device, which may or may not be equipped
with a transmitting antenna installed in the device header,
transmits required diagnostic data to the patient unit. The
transmission usually occurs in the 402- to 405 -MHz fre-
quency band, which is referred to as medical implant com-
munication service, or in other country-specific frequency
bands. Certain systems (Table 13.1 ) may also use a standard
telemetry wand to communicate with the implanted device.
The patient unit is connected to the management center via a
telephonic or data network; the center receives and evaluates
the data and distributes it to nursing staff or lower-tier medi-
cal centers. The data are transmitted on a regular basis, usu-
ally once a day; urgent information (such as a decrease in
battery energy, detection of a severe arrhythmia, etc.) is
transmitted immediately [ 89 ] .
13.2.2 Latitude Patient Management System TM
(Boston Scienti fi c, USA)
This system was launched in Europe in 2009. The patient
unit makes use of an analog line for the transmission of data
to the management center. The line has to be configured
specifically for the appropriate country. The possibility of
connecting a wireless scale and a blood pressure gauge to the
system for the purpose of monitoring progression of heart
failure makes the system unique. The patient may also enter
heart failure symptoms, such as fatigue, shortness of breath,
and swelling, in the system on a weekly basis. Event report-
ing may also be set individually. Furthermore, the system
allows optional transmission of data to various physicians,
which improves communication concerning heart failure
treatment [ 90 ] .
Table 13.1 Overview of basic remote patient monitoring systems
Home Monitoring TM
Latitude TM
CareLink TM
Merlin.net TM
Patient unit
Mobile
Fix
Fix
Fix
Data transfer to patient unit
MICS
ISM
MICS
MICS
Data transfer to center
GSM
Dial-up
Dial-up
Dial-up
Data transfer to center interval
Daily, serious events
Scheduled, serious events
Scheduled, serious events
Scheduled, serious events
Physician signalization
SMS, e-mail, fax
Fax, phone
SMS, e-mail
Fax, e-mail, SMS
Patient signalization
LED
Text or voice messages
LED
LED
MICS medical implant communication service LED light emitting diode ISM industrial, scientifi c, medical
 
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