Current Practices in the Monitoring of Cardiac Rhythm Devices in Pediatrics and Congenital Heart Disease

Abstract

Although guidelines for routine follow-up of pacemakers and implantable cardioverter defibrillators (ICDs) are available for adults, minimal data supports their appropriateness in pediatrics and congenital heart disease. This study aimed to define current practices of cardiac rhythm device (CRD) follow-up among pediatric electrophysiologists. Pediatric and Congenital EP Society (PACES) members were surveyed regarding frequency of CRD in-person follow-up as well as transtelephonic monitoring (TTM) and remote monitoring (RM) practices. If home monitoring was used, the effect on in-person follow-up was also evaluated. A total of 106 PACES members responded to the survey. Uncomplicated pacemaker and ICD patients were both followed in-person at a median interval of 6 months (range 1-12 months). TTM was utilized by 67 % of responders (median interval 3 months; range 1-6 months), while RM was used by 87 % for pacemakers (median interval 3 months; range 1-6 months) and 92 % for ICDs (median interval 3 months; range 2 weeks-6 months). When TTM was used, 21 % of responders reduced their frequency of pacemaker clinic visits. In comparison, RM reduced the frequency of clinic visits for pacemakers and ICDs in 32 and 31 % of responders, respectively. Patient age was an independent factor in determining CRD follow-up for 49 % of responders. While CRD follow-up by pediatric electrophysiologists in general follows adult guidelines, individual practices widely vary. In contrast to published recommendations in adults, TTM and RM utilization does not reduce the frequency of in-person visits for the majority of pediatric electrophysiologists.

Relevant Outcomes in Pediatric Acute Respiratory Distress Syndrome Studies

“…RTM devices have already been incorporated as interventions in clinical trials in adult heart failure ( 66 , 67 ). The use of RTM for patients with pacemakers and implantable cardioverter defibrillators by pediatric cardiologists was associated with fewer clinic visits ( 68 ), providing proof of concept for RTM to allow follow-up for patients at lower cost.…”

Long‐term follow‐up of adult patients with congenital heart disease and an implantable cardioverter defibrillator

“…RM of cardiac implantable electronic devices provides remote access to device battery, lead parameters and history of arrhythmias . Although there are currently no specific RM trials in the ACHD patients, one could assume that this population would derive at least the same benefit from RM as the general population. RM has already demonstrated to decrease the amount of outpatient and emergency room visits and to improve quality of life .…”

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients

“…At present, there are no established guidelines for CIED follow-up in the pediatric population with resultant variability in monitoring of pediatric CIEDs. 273,274 Several device, lead, and pocket complications can be seen within the first few days to weeks after CIED implantation, and an in-person evaluation (IPE) is useful in the early post-implant phase. [259][260][261][262][263] Ambulatory rhythm monitoring and/or exercise stress testing may be useful in patients with arrhythmia concerns or symptoms related to activity and to assist with device optimization.…”