Background/objective: A cardiac rhythm management (CRM) allied professional service was developed in 2015 utilising Medtronic Reveal LINQ ICM devices and advanced remote monitoring technology. Advances in technology have allowed for implantation in a procedure room by CRM specialist nurses and a cardiac physiologist. Following implant, all patients received remote monitoring equipment and access to a nurse-led telephone helpline. Daily assessment, management of patient transmissions and follow-up care by scheduled telephone appointments were coordinated by the CRM nurse team.
Outcomes were compared from the allied professional service versus traditional pathway over the preceding 5 years.
Results: Over a 36-month period 353 ICMs were implanted. Referral to ICM implant reduced from 49 to 24 days. Implant to definitive diagnosis reduced from 270 to 154 days. The conversion rate from ICM to PPM was 70/353 (19.83%); 50% AV node disease; 50% Sino-atrial node disease. 13.5% diagnosed with atrial fibrillation. Catheter laboratory time saved: 291 hours.
Appointment time was reduced from 4 hours to 1 hour. No complications occurred. Audit of patient experience demonstrated high levels of satisfaction with the nurse-led service.
Conclusion: The development of a CRM allied professional ICM service with use of remote monitoring have resulted in significant reductions in referral to ICM implant time; ICM implant to diagnosis times; higher than average diagnostic yield for pacing indication and atrial fibrillation, with high levels of patient satisfaction. Performing ICM implants in a procedure room has resulted in cost reduction, improved utilisation of cardiac catheter laboratory slots and consultant cardiologist time for more complex procedures, and the development of advanced skills within the allied professional team.