Transtelephonic monitoring

Transtelephonic pacemaker foUow-up is also appropriate in children, especially in those who have epicardial leads which function at low lead impedance and often with high thresholds. When such pacemakers are reaching end of service, the progression can be rapid. The provision of a transtelephonic monitor to pediatric pacemaker patients also makes it possible for the family to send transmissions after such events as collisions and other sports injuries, when families often need reassurance that the pacemaker is working normally. 

An integral part of many pacing system follow-up programs is transtelephonic monitoring (TTM) (72-74). This can be initiated by the physician and support staff out of an individual office or provided by a commercial service based on a specific prescription by the physician. Reports of each periodic evaluation are sent to the patient s physician. TTM provides a cost-effective means for frequent monitoring as the implanted device is getting older and there is concern about approaching RRT. It also provides a link between the patient and the physician for those patients who hve alone, who are very anxious, or pacemaker dependent. 

Transtelephonic monitoring commonly provides an emotional umbilical cord between the medical facility and the patient with many elderly patients being comforted by this contact. It is important to counsel the patient that, on occasion, there may be artifacts generated by the telephone lines that raise a concern about a pacing system problem. If these concerns cannot be cleared up by a repeat call, it may be necessary to have the patient come to the office for a detailed evaluation which provides far more information than is presently retrievable via the telephone. 

Fetter JG, Stanton MS, Benditt DG, Trusty J, and Colhns J. Transtelephonic monitoring and transmission of stored arrhythmia detection and therapy data from an implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 

Historically, device monitoring away from the clinic was accomplished transtelephonically. In these sessions, the patient dons wristband electrodes attached to a device that transmits a rhythm strip over a landline. More recently, advances in telecommunication technology have enabled the use of cell-phone-based transmission of essential data directly to a clinic, where it can be viewed via the Internet. This remote monitoring can provide valuable alerts when certain clinical criteria are met (Figure 11.7). 

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