RT-36
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Teleprogramming of cardiac pacemakers
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Ivo Cikes, Bozidar Ferek-Petric*, Vladimir Goldner, Damir Kosi, Martina Lovric-Bencic, Bruno Buljevic.
Clinic of Cardiovascular Diseases, University Hospital Rebro, *Medtronic, Zagreb, Croatia
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Abstract
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The hazard to the pacemaker patient can occur from either
an impeding pacing system failure, a cardiac pacing malfunction and disturbance, or a cardiac
arrhythmia. Many complications are transient and hardly detected, and a problem can remain
to be undetected for the lifetime of the patient. Trans-telephonic pacemaker monitoring is outdated
because the modern implantable devices comprise powerful diagnostic and telemetry means.
We developed an experimental system for the remote pacemaker follow-up utilizing the Internet
infrastructure. The follow-up system was built of custom developed hardware and software and
was designed as a client/server configuration with the server located locally to the patient and
the client locally to the operator. All of the software was written in the Java (SunSoft Inc.)
programming language. We selected to deploy the standard TCP/IP network protocol as a link
provider.We used an old model of the pacemaker programmer Siemens-Elema model 600 (Solna,
Sweden) that is normally operated utilizing the slide switches. A special hardware interface was
developed that connects the programmer to the server workstation via the standard parallel port
and takes over the switches closing control. Accordingly, the server software had the full control
of the programmer’s operation and state. The patient’s ECG signal was provided by means of
the digital ECG board. The client workstation’s graphic user interface comprises real-time ECG
screen and the programmer control commands. A group of 6 patients were selected who had
implanted functional Siemens-Elema (Solna, Sweden) pacemaker model Prolog being programmable
by means of the utilized programmer. We performed the remote follow-up session whereby battery
status, threshold and intrinsic rhythm were tested. The client workstation was 6 km distant from
the patient.
The follow-up sessions were completed in the manner as they would be done normally in the
follow-up room. We succesfully demonstrated all of the planned remote steps of the follow-up
session. There was no arrhythmia observed and there were no problems with the link between
the client and the server. The patients tolerated the procedure very good and they didn’t feel any
discomfort during the procedure and didn’t report any problems after the procedure. We believe
that our system is a very successful model for the future follow-up systems utilizing the modern
telecommunications technology.
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Key Words
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