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Aims: The majority of patients with pacemakers are very elderly, many being >85-years old. They often suffer from serious illnesses and have great difficulty in walking. The aim of our study was to compare remote pacemaker monitoring with in-home checks of pacemakers, in terms of applicability, efficacy, and cost in a selected population of debilitated elderly patients., Methods and Results: We selected 72 subjects (mean age 87 ± 8 years) among elderly debilitated patients with Medtronic pacemakers, compatible with the Carelink(®) remote monitoring system (13 patients with DDD pacemaker; 59 patients with single-lead VDD pacemaker). Remote follow-up was compared with in-home checks performed by nurses in 326 patients in similar clinical conditions. A total of 190 transmissions were received by remote monitoring (mean transmissions per month: 7.0; mean per patient: 2.6; range 1-6) during 27 months of follow-up. In this period, seven pacemakers were replaced owing to battery exhaustion, after a mean of 6.7 years from implantation. The occurrence of atrial or ventricular high-rate episodes was reported in 98 transmissions (53%). Nineteen patients died (annual mortality: 11.7%). On comparing the costs borne by the hospital for in-home checks, both for medical personnel and transportation, the estimated average saving was €32 per year per patient., Conclusion: Our study shows that the remote follow-up of pacemakers is a reliable, effective, and cost-saving procedure in elderly, debilitated patients. Moreover, remote controls provided an accurate and early diagnosis of arrhythmia occurrence.

Aims: The aims of this analysis were to assess the agreement between implantable defibrillator (ICD)-measured intrathoracic impedance and pulmonary capillary wedge pressure (PCWP) collected during long-term follow-up, as well as to evaluate whether PCWP measures may improve the performance of the impedance detection algorithm in predicting heart failure (HF) worsening., Methods and Results: We studied 23 HF patients implanted with an ICD capable of intrathoracic impedance measurement and alerting for fluid accumulation diagnosis. At regular follow-up and at visits for HF decompensation or device alert, clinical status was assessed and PCWP was non-invasively estimated with a validated echo-Doppler method. During 23 +/- 11 months, 45 paired assessments of impedance and PCWP were performed. The Kappa analysis revealed good agreement between impedance and PCWP (k = 0.701, SE 0.113, P < 0.001). Moreover, PCWP estimations and the paired values of the impedance fluid index resulted significantly correlated (r = 0.677, P < 0.001). The impedance-alert detected clinical HF deterioration with 92% sensitivity and 69% positive predictive value. The combined finding of decreased impedance and increased PCWP resulted in enhanced positive predictive value (92%) and no change in sensitivity (92%)., Conclusion: These data confirm the inverse correlation between impedance and PCWP at long-term follow-up and suggest the potential clinical value of a combined impedance and pressure assessment for the improved detection of HF deterioration.

Aims: The aim of this study was to evaluate the feasibility and reliability of selective-site pacing by means of a new lead system in a paediatric population. This lead system is composed of a 4.1 Fr, active-fixation lead and a steerable catheter that allows easy positioning in selective sites., Methods and Results: Thirty young patients (mean age 9.0 +/- 4.5 years, range 2-16 years) received a single- (10) or dual- (20) chamber pacemaker. The 3830 lead was implanted successfully in the targeted chambers in all patients. The selective RV sites of pacing in 26 of the patients were: 18 mid-septum, 5 outflow tract, 1 low-septum, and 2 LEVO-RV-Apex. In all patients, an intracardiac loop was left in order to avoid stretching of the lead with growth. Mean follow-up duration was 11 +/- 10 months. Atrial sensing and pacing thresholds were 3.2 +/- 1.7 mV and 0.8 +/- 0.6 V at 0.5 ms at implantation and 3.4 +/- 2.1 mV and 0.6 +/- 0.3 V at 0.5 ms at follow-up. Ventricular sensing and pacing thresholds were 12.1 +/- 4.9 and 0.7 +/- 0.4 V at 0.5 ms on implantation and 12.7 +/- 6.1 mV and 0.8 +/- 0.5 V at 0.5 ms at follow-up (P = NS). No adverse events were reported., Conclusion: Select Secure is a promising system for selective-site pacing in children.