Biomedical Engineering Reference
In-Depth Information
13.2.3 CareLink Network
TM
(Medtronic, USA)
or remote follow-up on the patient unit is a useful function.
The next generation of ICDs will measure pacing thresholds
of all leads, which will make complete remote patient moni-
toring possible [ 90 ] .
Currently, numerous clinical studies are being carried out
with an aim to prove operational safety and the possibility of
reducing routine follow-ups, be they scheduled or unsched-
uled (e.g., in the case of a defibrillation shock or suspicion of
improper functioning of the implanted system). The main
expected advantage of the monitoring systems being intro-
duced is the reduction in the number of follow-ups along with
the possibility to continuously monitor the patient's condi-
tion. Their importance even grows for patients with biven-
tricular systems because increased demands are laid on pacing
and, consequently, monitoring of implanted lead parameters.
Methods of payment for the introduction and administra-
tion of these systems and the protection of sensitive medical
data from abuse has not yet been solved and can be seen as
problematic. For the time being, the cost of implantation and
operation of the system is included in the cost of the implant-
able devices. It may be assumed, however, that the issue will
have to be dealt with in a systemic manner; this also applies
to the method of analysis and dealing with sudden events in
a patient. Today, physicians are overburdened by recordings
from monitoring systems and cannot pay sufficient attention
to the recordings; this will become an even more serious
problem as the expected number of devices and monitored
product categories increases.
The CareLink system was launched in the USA in 2002; in
Europe it has been available since 2007. The ICD communi-
cates with a patient unit within 3 m. Data are sent via an
analog telephonic line that is usable only in the patient's
home country. Upon the occurrence of a more serious event,
for example, an abnormal lead impedance, communication
between the ICD and the patient unit is immediately estab-
lished; failing that, attempts to establish communication are
repeated at an interval of 3 h for a period of 3 days; subse-
quently, sound signals are emitted. The remote monitoring
parameters may be set individually with a preset degree of
severity for each patient. It is advantageous that the latest
generations of devices are capable of conducting a wide
range of measurements automatically, including automatic
measurement of the threshold in the atrium and the right and
left ventricles, which makes full remote control of a patient
possible [ 90 ] .
13.2.4 Merlin.net
TM
(St. Jude Medical, USA)
The Merlin.net wireless patient unit was introduced in 2008.
The system communicates automatically with an implanted
device and sends data to the physician via an analog tele-
phone line; the use of a mobile network is planned. The pos-
sibility of signaling the results of a scheduled follow-up
