AF Association News & Events

Drive-through pacing clinic “fills gap” for patients who cannot use remote monitoring

Dr Zaki Akhtar (Department of Cardiology, Royal Surrey County Hospital, Surrey, UK) and colleagues report in a research letter, published in JACC: Clinical Electrophysiology, that a “drive-through” pacing clinic is an effective approach for reviewing patients with implantable cardiac devices when remote monitoring was not an option.

Akhtar et al report that social distancing measures, because of the COVID-19 pandemic, have meant that clinics have moved towards using remote monitoring systems, rather than in-person hospital visits, to follow-up patients with cardiac implantable electronic devices (i.e. pacemakers). However, they note: “Older devices lack this capability, some households do not have mobile signal coverage, some patients prefer to maintain contact with healthcare professionals, and some problems require in-person review.”

Therefore, to support patients for whom remote monitoring was not an option, the authors developed a drive-through clinic. The clinic involved patients staying in their vehicle, parking next to a fully equipped kiosk operated by a healthcare professional (who was wearing protective personal equipment) managing a programmer. They handed a programmer wand (contained within a disposable sterile polyethylene sleeve) to the patient to enable device interrogation. Through this approach, according to Akhtar et al, a full pacing check (including thresholds) was performed without a surface ECG using the device electrograms, and pacing parameters were optimised. Additionally, the healthcare professional carried out an in-person visual assessment of the implant site.

Over the course of the study, 316 patients attended the clinic. Of these, seven were diagnosed with new Atrial Fibrillation (AF) and referred for anticoagulation, 51 had their device settings optimised, and 22 were referred to a physician clinic for a range of symptoms. Also, of 50 wound inspections that were performed, two superficial infections were identified, and these were resolved with a course of antibiotics. A questionnaire of those who attended the drive-through clinic found that patients were extremely satisfied with the novel setup and preferred it over the conventional pacing clinic during the pandemic.

“Remote monitoring has been adopted widely during the pandemic but is not suitable for all patients. The drive-through pacing clinic filled this gap without compromising biosecurity,” the authors comment. They add that the clinic “minimises the risk of contracting COVID-19 without compromising care”. Akhtar et al conclude: “The drive-through pacing clinic is feasible and effective, with some advantages over remote monitoring during the pandemic.”

According to Dr Akhtar, to hire and use the kiosk for the drive-through clinic costs about £350 per week. “In the kiosk, we also setup a laptop which was fully (and securely) wired and connected to the trust network. There was also a phone to allow communication with patients and colleagues (including the consultants). I think the drive-through clinic would also work perfectly well for patients who do not have a car. For example, they could arrive in a taxi, on a motorbike, bicycle and even in a bus! As long as the patient is accessible, the clinic will work perfectly fine!”

Wythenshawe Hospital (Manchester, UK) and Bart’s Heart Centre (London, UK) have also used innovative approaches, employing wireless technologies, to safely assess patients with implantable cardiac devices during the COVID-19 pandemic. For more information on their approaches, watch the Partner in Care video on the Medtronic stand on the Arrhythmia Alliance Heart Rhythm Congress 2020 platform.

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