Currently available transmitters from different device manufacturers.

(A) Biotronik Home Monitor showing trends of AS–VS events (black dots) and As–Vp events (blue diamonds). Alerts of reduced (< 85%) CRT delivery are indicated (‘CRT low’ arrows) and coincide with increased percentage of AS–VS events (black dots). This would suggest that the AV interval is programmed too long. (B) The real-time EGM strip available by remote monitoring however shows that the AS–VS events are due to premature atrial beats (red asterisks) with a short intrinsic AV interval (most probably due to proximity of the ectopic focus with the AV node). Doses of beta-blockers were increased, with improvement in CRT delivery.

Remote monitoring parameters (print screens) for CRT-D devices available at the University Hospital of Geneva at the time this manuscript was submitted. The Biotronik Lumax-540 CRT-D (left) can be fully configured online. Parameters of a Medtronic Consulta CRT-D (right) can be defined as red or yellow alerts (or website alert only) that trigger different urgencies of notification.

A 66-year-old patient with a Medtronic Concerto CRT-D for primary prevention of sudden death phoned the clinic complaining of fatigue since 2 days, without any malaise or ICD shocks. (A) Remote interrogation of the device with the real-time 10 s rhythm strip (partly displayed) showed slow irregular VT (a ventricular far-field is seen in the atrial EGM). No episodes of SVT or ventricular arrythmias (faster than 140 b.p.m.) were recorded by the device. On the basis of the EGM findings, the patient was asked to come directly to the clinic. (B) Immediately upon arrival in the clinic 15 min later, the patient collapsed due to rapid incessant ventricular tachycardia (VT) that led to 22 ICD shocks. Injection of amiodarone resulted in slowing and finally disappearance of the VT. The patient developed multiorgan failure, but recovered subsequently and was seen in-office 1 month later, with no events. (C) Print screen of the CareLink website of remote interrogation of the device 6 months after the arrhythmic storm (asterisk) showing no arrhythmia (faster than 113 b.p.m.), with improvement of the patients’ physical activity (arrow).