Mobile Telemonitoring for Arrhythmias in Outpatients in the Republic of Georgia: A Brief Report of a Pilot Study

Introduction

Mobile telehealth (m-health) is a rapidly growing branch of telemedicine. It includes the practice of medicine and public health using mobile devices, such as mobile phones and personal digital assistants, for providing health services and information.

In the process of m-health, broadband mobile connectivity enables data transfer among medical patients and health professionals. Increased availability of cell phones, increases in coverage zones, bandwidth-rich applications, and affordability of services have allowed the growth of m-health as a cost-effective tool. In transition economies, the lack of expensive technology and communications infrastructure are barriers to telemedicine development. However, mobile communications networks exist now. ^1,2

In the Republic of Georgia, mobile communications have grown rapidly since 1996. General packet radio service and 3G provide a means for monitoring outpatients in their homes and in isolated areas, such as mountainous regions, particularly during snowy winters. Mobile telemedicine systems can be used to diagnose arrhythmias and initiate/monitor therapy.

A classical example demonstrating the impact of telemedicine on diagnosis is the event recording of cardiac arrhythmia. ^{3 –5} The documentation is a prerequisite for the subsequent diagnosis and therapy. Event recording also enables the correlation between the arrhythmia and the complaints of the patient and allows evaluating the quantity and quality of clinically relevant arrhythmias. Radiofrequency catheter ablation is an effective treatment of arrhythmias. However, patients may often have recurrent asymptomatic arrhythmias even after the procedure, which requires thorough ECG monitoring. ⁵ In addition, the impact of medication change on arrhythmias can be more objectively assessed with electrocardiogram (ECG) telemonitoring on outpatients.

Subjects and Methods

During June–December 2010, we studied 35 outpatients with different types of arrhythmia (male/female ratio=16/19; 12–80 years old), among them 5 patients with concomitant epilepsy, 2 patients after radiofrequency catheter ablation, 1 patient after aorta-coronary bypass graft surgery, and 2 patients with unexplained syncope. The control group comprised 7 clinically healthy sportsmen (soccer players, all men; 15–17 years old), during a 30-min velo ergometer stress test. Investigations were conducted with a three-lead ECG loop recorder (Vitaphone BT 3300; Vitasystems GmbH, Mannheim, Germany) in automatic recording/transmitting mode, using special LRMA software (MDT, Lázně Bohdaneč, Czech Republic) and a Nokia (Espoo, Finland) 6730 smartphone. Patients' ECGs after automatic recording by the loop recorder were transmitted by Bluetooth^® (Bluetooth SIG, Inc., Kirkland, WA) to a phone and then by 3G communication (supported by our partner mobile operator, MagtiCom Ltd. [Tbilsi, Georgia]) to the Vitasystems server in Germany and were available to Georgian physicians via e-mail/Internet (delay from recording, 30–70 s).

Results

Arrhythmias were recorded/monitored for 7–68 h. Significant ECG events varied from 3 to 170 per observation, or 0.4–10.7 events/h. Minor artifacts were observed mainly in the first minutes of recording (<4% of subjects) and during vigorous exercise (12% of subjects, mainly in the control group of sportsmen). Cases of sinus bradyarrhythmia and tachyarrhythmia, sick sinus syndrome (prolonged sinus pauses or severe sinus bradycardia), atrial fibrillation, paroxysmal supraventricular tachycardia (PSVT), premature atrial complexes, and premature ventricular complexes (PVCs) were recorded and correctly recognized by the automatic recognition software. In 3 patients and 1 sportsman previously undiagnosed, arrhythmias were recorded: 1 with PSVT, 1 with sick sinus syndrome, and 2 with PVCs. Thirty patients reported no issues with the evaluation, but 2 women had light insomnia and nervousness, and 2 elderly men did not complete the evaluation because of anxiety/agitation. Two patients who had had radiofrequency catheter ablation had arrhythmia relapses recorded, but they were mostly asymptomatic. The vast majority of the 12 arrhythmia events were trivial—isolated premature atrial complexes/PVCs or sinus tachycardia—and only 2 were symptomatic. One patient had episodes of PSVT in 48 h of recording, and another had two episodes of PSVT and PVCs in 72 h of recording (all were asymptomatic).

Conclusions

This pilot study in Georgia has demonstrated the feasibility, reliability, and efficiency of telemonitoring outpatients for arrhythmias. Mobile telecardiology monitoring of arrhythmias enables early diagnosis and more timely intervention to support more cost-effective management and improved quality of care. It also permits evaluations by specialists not available in remote areas and the evaluation of the effects of pharmacologic and invasive interventions (radiofrequency catheter ablation and pacemaker or automatic/artificial implantable cardioverter defibrillator insertions).