Interventional cardiology

CSANZ releases guidance on implanted device follow-up

A hybrid model of care including remote monitoring of cardiovascular implanted electronic devices (CIEDs) and in-person follow-up is the standard of care for patients with implanted cardiac rhythm devices.

A CSANZ position statement, published in Heart, Lung and Circulation, did not stipulate a mandatory minimal interval for in-person device checks.

“In some instances, all required information is obtained from a remote scheduled transmission, device programming is not indicated and an additional in-person device check would be low value care, adding little or nothing to device management,” the statement said.

“Nonetheless, periodic, in-person review is an essential aspect of follow-up care for all patients to manage the underlying cardiac condition as well as for device management.”

The statement included general requirements for interrogation, programming and testing of implantable loop recorders, permanent pacemakers, implantable and subcutaneous cardioverter-defibrillators, and conductions system pacing and cardiac resynchronisation therapy.

Regarding congenital heart disease patients, the statement said children also require special considerations in relation to growth and the potential change to requirement of pacing.

“Almost all CIED implantations and long-term treatment plans require tailoring to each individual patient due to the heterogeneity of the patient group.”

“In addition to monitoring the CIED itself, it is crucial to evaluate CIED-related consequences frequently with ancillary testing, such as 12-lead ECG, Holter monitoring, exercise stress test and chest X-ray,” it said.

“Given rapid physiologic changes in young children and disease related changes in patients with congenital heart disease, ancillary testing may need to be repeated periodically.”

“At least one annual in-person CIED check and cardiology review is recommended in paediatric patients. Remote transmission in the interim is recommended every 3-12 months for pacemakers and 3-6 months for ICDs.”

The position statement said that the safety of cardiovascular implanted electronic device (CIED) patients relies on competent support by a cardiac device physiologist.

“The writing committee recommends a co-ordinated national approach to training and credentialling of cardiac device physiologists in Australia, similar to that available in New Zealand.”


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