My Opinion

---

Cardiac telemetry has been used inappropriately due to the lack of evidence based guidelines for initiation and discontinuation of the telemetry [1-4]. Additionally, cardiac telemetry in itself is imperfect for monitoring the mechanical activity of the heart which is an essential monitoring parameter for patients with permanent pacemaker. The pacemakers can easily override deteriorating intrinsic rhythms and replace it with pacemaker rhythm even though the cause of loss of intrinsic rhythm may be interfering with the cardiac contractility. Even the Closed Loop Stimulation (CLS) in the pacemakers by BIOTRONIK^® (Berlin, Germany) with capability to measure the intra-cardiac impedance for early detection and response to the deterioration in contractility does not overcome the shortcoming of cardiac monitoring by inpatient telemetry because the BIOTRONIK^® Home Monitoring is yet not synchronized in real time to the inpatient cardiac telemetry. Therefore, pulseless electrical activity (PEA) remains a big challenge for cardiac telemetry. PEA usually deteriorates into bradycardia (slow PEA) that rapidly converts into asystole because the blood supply to the cardiac conduction system has been abruptly shut off by the absence of contractility. However, when the patient has a pacemaker, the pacemaker spikes override the slow PEA rhythm with no display of impending/ongoing asystole that can go unnoticed on remote telemetry before the patient’s physical condition is reassessed and reviewed by other means. To avert this life-threatening scenario, it seems prudent to simultaneously telemonitor cardiac contractility by other means [5] including but not limited to intra-arterial catheter (IAC) waveform, continuous echocardiography (ECHO) and pulmonary artery catheter (PAC) waveform. However, these invasive monitoring devices require patient’s continuous stay in intensive/intermediate care unit. Therefore, the most amenable solution for transferring the patients with pacemakers to floor beds is that cardiac telemetry should be integrated with continuous wireless monitoring of non-invasive photoplethysmograph and/or respiration because photoplethysmograph waveform and acoustic respiration monitoring communicate the global effect of loss of cardiac contractility. This integrated monitoring will keep the patients with permanent pacemakers safe, mobile and comfortable outside the cost-ineffective domains of the modern day intensive care units.

References

---

1.Henriques-Forsythe MN, Ivonye CC, Jamched U, Kamuguisha LK, Olejeme KA, Onuwuanyi AE.Is telemetry overused? Is it as helpful as thought? Cleve Clin J Med. 2009; 76: 368-72.
2.Reilly T, Humbrecht D. Fostering synergy: a nurse-managed remote telemetry model. Crit Care Nurse. 2007; 27: 22-6, 29-33.
3.Dhillon SK, Rachko M, Hanon S, Schweitzer P, Bergmann SR. Telemetry monitoring guidelines for efficient and safe delivery of cardiac rhythm monitoring to noncritical hospital inpatients. Crit Pathw Cardiol. 2009; 8: 125-6.
4.Tiongson J, Robin J, Chana A, Shin DD, Gheorghiade M. Are the American College of Cardiology/Emergency Cardiac Care (ACC/ECC) guidelines useful in triaging patients to telemetry units? Acute Card Care. 2006; 8: 155-60.
5.Chiu WC: Cardiovascular monitoring. In: Trauma: Critical Care. Edited by Wilson WC, Grande CM, Hoyt DB. New York, Informa Healthcare USA, Inc. Publishers, 2007, pp 155-6.

Source(s) of Funding

---

none

Competing Interests

---

none

Disclaimer

---

This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.