Remote monitoring!

Alart received through Merlin.net^TM from a single-chambre ICD (SJM Fortify, 2012). This alert was triggered by an RV ICD-lead impedance of >300 Ohms. Patient was implanted in 2003 with a Medtronic lead (model 6945). In addition, a fall in sensed amplitude is seen on the graph (in the order of 12 to 4 mV). In case of SJM, it is imperative to always check sensed amplitude since there is no alert for this. There were no arrythmias detected (see table).

We called in the patient for outpatient clinical consultation the same day.

When interrogating the device an epsode was found (page 4 of the PDF) which occurred during the patient travel towards the hospital which was diagnosed as VF. This episode was in fact triggered by RV lead noise, systematically occuring during deep inspiration and during manipulation of the can. The lead was indeed broken.

Without remote monitoring, this patient would have certainly received inappropriate therapies. We added a new ICD-lead and the patient was discharged without realizing he barely escaped catastrophy...  

So, remote monitor your patients!