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Empfehlungen zum Telemonitoring bei Patienten mit implantierten Herzschrittmachern, Defibrillatoren und kardialen Resynchronisationssystemen

Recommendations for telemonitoring in patients with implanted pace makers, defibrillators, and cardiac resynchronization systems

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Der Kardiologe Aims and scope

Zusammenfassung

Telemonitoringsysteme stehen heute zur Überwachung von Patienten mit implantierten Herzschrittmachern, Defibrillatoren (ICD) und kardialen Resynchronisationssystemen (CRT) in der klinischen Praxis zur Verfügung. Trotz unterschiedlicher technischer Umsetzungen der Hersteller haben diese Systeme einen einheitlichen Aufbau. Mit Telemonitoring können Daten zum Aggregat-, Arrhythmie- und Herzinsuffizienzmanagement zeitnah übertragen werden. Die Ärzte können über passwortgeschützte Internetplattformen jederzeit sicher auf diese Daten zugreifen.

In den letzten Jahren wurden randomisierte klinische Studien zum Telemonitoring bei Patienten mit implantierten Aggregaten abgeschlossen.

Durch Telemonitoring sind aggregatbedingte und klinische Ereignisse frühzeitiger erkennbar, die Einleitung entsprechender klinischer Reaktionen zeitnaher möglich. Routinekontrollintervalle können individuell optimiert und Kosten somit reduziert werden. Bei Patienten mit chronischer Herzinsuffizienz kann durch eine telemedizinische Überwachung der CRT- bzw. ICD-Systeme eine drohende kardiale Dekompensation früher erkannt werden. Trotz der positiven Ergebnisse für das Telemonitoring bleiben einzelne Fragen zu Langzeitergebnissen und Kosteneffizienz noch offen. Rechtliche Probleme in der Fernüberwachung sind heute weitestgehend gelöst und die ärztliche Leistung über eine EBM-Ziffer abrechenbar. Trotz dieser Entwicklungen existieren zurzeit noch Barrieren in der Umsetzung telemedizinischer Überwachungskonzepte bei Patienten mit implantierten Aggregaten.

Heute sollte schon bei Implantation, insbesondere von CRT- und ICD-Systemen, die Option einer telemedizinischen Überwachung der Patienten in das Gesamtbehandlungskonzept einbezogen werden. Das Ziel muss dabei sein, aus den gewonnenen Informationen zeitnah klinische Aktivitäten abzuleiten. Dafür ist eine entsprechende Logistik und geschultes Personal erforderlich.

Aufgrund der aktuellen Studienlage wird insbesondere für Patienten mit ICD-Systemen (Primär- und Sekundärprophylaxe) und CRT-Systemen der Einsatz des Telemonitorings empfohlen.

Abstract

In clinical practice, telemonitoring systems are available today to monitor patients with pacemakers, defibrillators (ICD), and cardiac resynchronization systems (CRT). Despite the various technical realizations by manufacturers, these systems have uniform designs. With telemonitoring, data important for the management of the unit, arrhythmia, and heart failure can be transmitted in real-time. The physicians have access to these data at all times via a password-protected internet platform.

In recent years, randomized clinical trials on telemonitoring have been completed in patients with implanted units.

Using telemonitoring, it is possible to identify unit-associated and clinical events earlier, which allows clinical actions to be initiated earlier and the routine check-up intervals of the patients to be individually optimized. Costs are also thereby reduced. In patients with chronic heart failure, telemedical monitoring of CRT or ICD systems can identify life-threatening cardiac decompensation. Despite the positive results for telemonitoring, questions remain concerning long-term results and cost efficiency. Legal problems in telemonitoring have been solved for the most part and the medical services provided can be reimbursed using an EBM number. Although progress has been made, barriers in the implementation of telemedical monitoring concepts in patients with implanted units still exist.

Today, the option for telemedical monitoring of the patient should be included in the overall treatment concept already at the time of implantation, especially for CRT and ICD systems. The goal is to be able to take clinical actions from the information obtained in a timely manner. Appropriate logistics and trained personnel are thus required.

Based on the current literature, the use of telemonitoring is recommended, especially for patients with ICD systems (primary and secondary prophylaxis).

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Abb. 1

Abbreviations

CRT:

Kardiale Resynchronisationstherapie

CRT-D:

Kardiale Resynchronisationstherapie mit Defibrillator

CRT-P:

Kardiale Resynchronisationstherapie mit Schrittmacher

ICD:

Implantierbarer Kardioverter/Defibrillator

IEGM:

Intrakardiales Elektrokardiogramm

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Authors and Affiliations

  1. Klinik für Innere Medizin I, Krankenhaus Küchwald der Klinikum Chemnitz gGmbH, Bürgerstr. 2, 09113, Chemnitz, Deutschland

    A. Müller

  2. Kardiologische Praxis, Kochstedter Kreisstr. 11, 06847, Dessau-Roßlau, Deutschland

    K. Rybak

  3. Praxis für Kardiologie und Ambulante Herzkatheter-Kooperation, Im Mühlenbach 2 B, 53127, Bonn, Deutschland

    T. Klingenheben

  4. Medizinische Klinik II, Westpfalz-Klinikum, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland

    B. Schumacher

  5. Klinik für Innere Medizin – Kardiologie und Angiologie in Bethel, Evangelisches Krankenhaus Bielefeld, Burgsteig 13, 33617, Bielefeld, Deutschland

    C. Israel

  6. Deutsche Stiftung für chronisch Kranke, Alexanderstr. 26, 90762, Fürth, Deutschland

    T.M. Helms

  7. Klinik für Innere Medizin I, Kardiologie, Pulmologie und Angiologie, Städtisches Klinikum Brandenburg, Hochstr. 29, 14770, Brandenburg, Deutschland

    M. Oeff

  8. Medizinische Klinik I, Klinikum Lünen, St. Marien-Hospital GmbH, Altstadtstr. 23, 44534, Lünen, Deutschland

    C. Perings

  9. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Schwabingen, Städtisches Klinikum München GmbH, Kölner Platz 1, 80804, München, Deutschland

    S. Sack

  10. Abteilung für Rhythmologie, Herzzentrum Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland

    C. Piorkowski

  11. Kanzlei Preissler, Ohlmann und Partner, Alexanderstr. 26, 90762, Fürth, Deutschland

    R. Preissler

  12. Innere Medizin III (Kardiologie, Angiologie und Pulmologie), Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland

    C. Zugck

  13. Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    J.O. Schwab

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  1. A. Müller
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  5. C. Israel
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Correspondence to A. Müller.

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Müller, A., Rybak, K., Klingenheben, T. et al. Empfehlungen zum Telemonitoring bei Patienten mit implantierten Herzschrittmachern, Defibrillatoren und kardialen Resynchronisationssystemen. Kardiologe 7, 181–193 (2013). https://doi.org/10.1007/s12181-013-0496-1

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