In another study Lopez and associates found that patients wi
In another study Lopez and associates found that patients with chronic heart failure receiving torsemide, a loop diuretic that inhibits the enzyme involved in the myocardial extracellular generation of collagen type I molecules (i.e., procollagen type I carboxy-terminal proteinase or PCP), had reduced myocardial collagen volume fraction (CVF) as assessed in right septal endocardial biopsies . Interestingly, changes in serum PCP activation were positively correlated with changes in CVF in the patients receiving torsemide . These initial clinical studies suggest that ventricular fibrosis may indeed be decreased using antifibrotic therapy; however, its antiarrhythmic significance awaits confirmation in larger patient populations. The emergence of new cardiac imaging techniques for myocardial fibrosis with reasonable degrees of accuracy  may help assess the efficacy of antifibrotic therapy for the associated cardiac arrhythmias. Antiarrhythmic therapy would thus be targeted to prevent disproportionate collagen accumulation and myofibroblast proliferation. Such measures will not only prevent arrhythmias, but also help in the management of heart failure. Collectively, there are a wide range of possible preventive antifibrotic treatment options that target TGF-β, endothelin-1 (ET-1), smo inhibitor growth factor (CTGF), angiotensin II, and platelet-derived growth factor (PDGF) networks . The experimental findings are encouraging, and suggest that reduction of cardiac fibrosis is possible and may indeed reduce the risk of cardiac arrhythmias. For example, studies in rats have shown that pirfenidone mitigates left ventricular fibrosis and dysfunction after myocardial infarction and reduces arrhythmias [49,50] Another animal study showed that the agent relaxin-1 reverses cardiac fibrosis and related cardiac dysfunction . Relaxin is a potent antifibrotic peptide hormone that inhibits fibroblast activation (indicated by suppressed expression of α-smooth muscle actin) and collagen synthesis stimulated by angiotensin II or TGF-β .
Conflict of interest
Acknowledgments This study was supported by AHA Western State Affiliate Research Fellowship Award (0725218Y) and a Grant-in-Aid (0555057Y), and National Institutes of Health GrantsP01 HL-78931.
Introduction Patients with cardiac implantable electronic devices (CIEDs) have been followed with periodic clinic visits and have received direct interrogation by a programmer which checks the battery, lead impedance, sensing amplitude, pacing threshold, and arrhythmic events. The number of patients with CIEDs has been increasing and CIEDs have become more complex. Follow-up frequency varies depending on the facility, physician preference, and available resources. Checks at clinics every 3–6 months have been recommended with increased frequency in response to product advisories and recalls . The workload of both medical staff and patients for CIED follow-up has also been increasing. Technology-assisted medicine has provided many benefits. Remote monitoring (RM) technology has undergone many developments from the original transtelephonic monitoring of pacemakers for battery levels to currently available CIEDs with wireless telemetry capabilities. Various developments have occurred over the past decade, from fax reports to a social networking service system, from wired interrogation to wireless interrogation, and from one-direction transmission to bidirectional transmission. In Japan, RM has been used since 2008. Currently, 5 CIED companies in Japan use RM, and 27,700 patients in total have been followed as of December 2013. Because RM is a new technology, endocrine system has both benefits and problems.
Technological aspects of remote monitoring RM data are transmitted from CIEDs to a transmitter station (Fig. 1) either by wired or wireless communication. Two types of transmitters exist: stationary and mobile transmitters. Only stationary transmitters are used in Japan. In addition to scheduled data transmission, alert-triggered data can be transmitted depending on the CIED . Such a transmitter is linked by a telephone line to a central secure server website to store the transmitted data for further analysis. Companies use various telephone line types, including analog landlines, digital landlines, and a global system for mobile communications (GSM) network. It is sometimes difficult to set up a landline transmitter because a cable must connect the transmitter and the landline connector. Since RM data are likely to be transmitted at night, the transmitter should be set up in the bedroom rather than the living room. However, in traditional Japanese homes, there are no landline connectors in bedrooms. A GSM transmitter would be appropriate for such homes. After successful transmission of RM data, medical staff can check detailed RM data on a website from anywhere. The volume and nature of transmitted data are almost the same as those of the data obtained from direct interrogation. Medical staff can receive alert notifications by fax, SMS, voice message, or email. Occasionally, we can receive precise RM data immediately following an event such as appropriate implantable cardioverter defibrillator (ICD) therapy, inappropriate ICD therapy, and CIED abnormality. Medical staff can also manually or automatically activate message calls to patients to remind them of abnormalities. However, since elderly patients may be unaware of an abnormal signal, a telephone call may be necessary to notify them of abnormalities. The Table 1 shows RM characteristics by company.