Attitudes of Implanting Physicians about Cardiac Rhythm Management Devices and Their Features

Modern cardiac rhythm management systems have become increasingly complex. The decision on which specific system to implant in a given patient often rests with the implanting physician. We conducted a multiple-choice survey to assess the opinions and preferences of cardiologists and electrophysiologists who implant and follow cardiac rhythm management systems. Reliability and battery longevity were viewed as the most important characteristics in device selection. Patient characteristics which most affected device choice were pacing indication and life expectancy. Remote technology was used in 47% of pacemaker patients, 64% of ICD patients, and 65% of CRT-D patients, with wireless (radiofrequency) remote patient monitoring associated with higher patient compliance rates (74% versus 64%, resp.). Wireless remote patient management with alerts for atrial tachyarrhythmias was felt to be important by 76% of respondents. When choosing an MR-conditional device, physicians deemed patients with prior orthopedic problems, a history of cancer, or neurological disorders to be more likely to require a future MRI. Device longevity and reliability remain the most important factors which influence device selection. Wireless remote patient monitoring with alerts is considered increasingly important when choosing a specific cardiac rhythm management system to implant. 1. Introduction Modern cardiac rhythm management (CRM) devices range from single-chamber pacemakers to implantable cardioverter-defibrillators (ICDs) with cardiac resynchronization therapy (CRT). The decision of which device to implant in a given patient often rests with the implanting physician. Over the past decade, these devices have increased not only in number, but also in features offered; for that reason, many factors influence device selection. We report here on results of a survey conducted among electrophysiologists (EPs) and cardiologists aimed at determining factors that influence device selection for their patients. A major recent breakthrough in cardiac rhythm management has been the advent of remote technology, which today is available in pacemakers as well as ICD and CRT-D systems. Remote technology today includes “remote follow-up,” in which data can be periodically downloaded from the device, either through patient interaction with a transmitter system (inductive systems) or automatically (wireless) with no patient participation. Remote follow-up allows clinics to perform periodic routine patient check-ups without the need for an in-clinic visit. Wireless systems enable the further