TRANSTELEPHONE MONITORING FOR PACEMAKER FOLLOW-UP 1981-1994

Transtelephone monitoring (TTM) is capable of detecting pacemaker puls e generator malfunction, battery depletion, and lead failure. The accu racy of TTM was analyzed by a review of Montefiore Medical Center reco rds between October 1981 and March 1944. Each group of transmissions f rom a single patient, starting with implant and ending with a pacemake r operation, was defined as a closed cycle (CLOSE), if undergoing cont inuing follow-up at the time of analysis, as a continuing cycle (CONT) , and if a cycle had ended with death or loss to follow-up, an open cy cle (OPEN). TTM records of 2,632 patients were analyzed, providing 3,2 91 cycles. There were 731 CONT, 433 CLOSE, and 2,127 OPEN cycles; 331 procedures were indicated by TTM, of which 279 were impending depletio n, 30 sudden depletion, and 22 lead malfunctions. Of the 102 procedure s not indicated by TTM, 85 were for nonurgent reasons (recall: 41; DDD upgrade: 16; patient/MD request: 28) and 17 for urgent reasons. In pa tients followed by TTM who had a lead problem, 22 were detected by TTM before clinical manifestations and 16 were not. There were no cases i n which TTM followup did not detect battery depletion. The total numbe r of TTM contacts, available for 3,094 cycles, was 88,654 (range, 1-16 3, median 19), of which 0.4% yielded a procedure. During the same peri od, 75% of all secondary interventions during the first 2 years occurr ed during the first 2 months after implant because of lead malfunction , with a subsequent SI rate of 0.005 per month for the third through t he twenty-fourth months.