Telemonitoring with Electronic Devices in Patients with a Single Ventricle Anatomy

Figures

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  Fig. 1. Different electric vectors and defibrillator fields between transvenous pacemaker (P) and defibrillator (D) systems ( a ), compared with epimyocardial systems ( b, c ).

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  Fig. 2. A 32-year-old man with Fontan circulation on the basis of a tricuspid valve atresia and unclear syncope received a subcutaneous event recorder. Antiarrhythmic therapy was initiated with bisoprolol and amiodaron. Being on holiday, he suffered from dyspnea and dizziness. Telemonitoring revealed atrial flutter. Coming back from holiday 3 days later cardioversion was successful and the amiodaron dose was increased. During the first follow-up days still some self-limiting flutter episodes occurred, but ceased later on.

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  Fig. 3. Thoracic impedance of a patient with an unbalanced atrioventricular channel with a dominant left ventricle and Fontan circulation. The patient is 22 years of age and suffering from persistent ascites, low albumin, and recurrent edema of the lower limbs. Diuretic medication with torasemide proved insufficient and was temporarily supplemented with an additional dose of tolvaptan, which lost its effect after weaning. As an alternative, xipamide showed very effective and was maintained in low dose.

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  Fig. 4. While reducing furosemide, a 20-year-old woman with a double outlet left ventricle after Fontan palliation showed an OptiVol fluid index above its threshold and clinically an increasing dyspnea (the OptiVol fluid index is an accumulation of the difference between the daily and reference impedance [standard is 60 Ohm]). As a consequence, furosemide was reinstalled in its prior dosage and the index as well as the respiratory rate improved. This was monitored online with just one in-clinic visit.