Transtelephonic monitoring (TTM) is a technology that allows patients to report symptoms and/or transmit data from a medical device (usually a pacemaker) over the phone for medical evaluation by their physician. TTM may be used to allow patients to have their pacemaker checks done over the phone, or to transmit data from an electrocardiograph (EKG) machine over the phone for evaluation. Signals from the devices are converted into sound waves, sent over the phone, received by the monitoring station at the other end of the phone, and reconverted back into the original signals. TTM may be significantly more convenient and less time-consuming than an office visit, but this technology is not a substitute for physician evaluation or the physician-patient relationship.

It is important to note that data cannot be transmitted to a monitoring station by cordless phone, including cell phones, because of electronic interference.

Transtelephonic monitoring (TTM) is a technology that allows patients to report symptoms and/or transmit data from a medical device (usually a pacemaker) over the phone for medical evaluation by their physician. TTM is useful in evaluating symptoms that occur only rarely and/or sporadically, which may not show any signs during a routine office visit. Data that is transmitted can also help the physician evaluate and fine tune medications that were prescribed to the patient, such as antiarrhythmic drugs. For patients recovering from a heart attack, TTM can monitor their progress upon being discharged from the hospital.

When unusual symptoms occur, the patient can phone the monitoring station and do one or more of the following:

Patients are normally requested to transmit their data every one to two months, or whenever the patient or the physician is concerned that the device is not functioning normally.

If the TTM is going to be done for a patient with a pacemaker no preparation is necessary. The patient should call the number provided by the physician and then place the TTM over the device. The data stored on the pacemaker will then be transmitted through the phone line to be stored and analyzed later.

If the TTM is going to be done while the patient is wearing a portable EKG (e.g., a Holter monitor) then the device will need to be properly placed. A portable EKG measures heart activity while the patient is “on the move” instead of in a physician’s office. The heart's electrical activity is recorded on a portable tape inside the machine. There are two categories of ambulatory electrocardiography (AECG) recorders:

As with the in-office EKG, the patient is hooked up to electrodes that are connected to the monitor. Once the electrodes are firmly attached, patients are instructed on monitor use and sent home to go about their usual daily activities. Bathing is prohibited while using the machine, but most other daily activities are acceptable.

Patients should keep a diary of activities and any symptoms that take place during the monitoring period so the physician can compare this to the data received from the device. In order to transmit the data over the telephone, an electronic monitoring device is attached to the patient’s skin and to the telephone on the other end. 

It is important to note that data cannot be transmitted to a monitoring station by cordless phone, including cell phones because of electronic interference.

EKG information that is sent over the phone to a monitoring station is received and printed out on standard EKG readout paper. The information may be received by a technician, nurse, physician or computer. During non-business hours, an answering machine with special recording capabilities can be used to receive the transmissions. If a phone is not immediately accessible to the patient, he or she can record the event on an intermittent recorder that will store the data in its memory until such a time that it can be transmitted across phone lines for evaluation.

It is important to note that medical personnel do not recognize an EKG that has been read by a computer alone as an EKG that has been interpreted or evaluated. Technology that allows data to be transmitted over phone lines is not a substitute for physician evaluation or the physician-patient relationship.

Advantages of TTM for a portable EKG include:

Disadvantages of TTM for a portable EKG include:

• The equipment will not work if improperly activated or misused.
  
  
• The equipment may not detect some abnormal heart rhythms (arrhythmias) and slow heartbeats (bradycardia).
  
  
• Landline telephone availability is required in most cases. Cordless phones and cell phones cannot be used because of electrical interference.
  
  
• Very brief symptoms may not be adequately recorded.
  
  
• A fainting episode (syncope) may go unrecorded while the patient is unconscious and unable to use the phone.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to transtelephonic monitoring (TTM):

1. Do I require TTM?
   
   
2. Are there any maintenance issues involved with TTM?
   
   
3. How often will I need to come back in for a physical check-up?
   
   
4. Will I need to be on medication also?
   
   
5. Will I need a working phone line to use this method?
   
   
6. Will I ever be able to feel the TTM device functioning?
   
   
7. What level of physical activity is acceptable? Is it possible to launch an exercise program?
   
   
8. Is there any chance the TTM device will stop working? How will I know if it's defective?
   
   
9. Will I experience any symptoms if there's a problem with the device?
   
   
10. Can I use a cell phone or cordless phone to transmit the data?