title: Usefulness of transtelephonic monitoring in epicardial pacemaker systems.
abstract: BACKGROUND
  Transtelephonic monitoring (TTM) of pediatric patients with cardiac pacemakers (PMs) has been shown to have high sensitivity and specificity in identifying PM malfunction. The objective of this study is to determine if there is a difference in the rate of abnormal TTM findings in transvenous versus epicardial PM systems.
  
  
  METHODS
  Our TTM database was reviewed. Patients younger than 21 years of age enrolled for TTM between 1990 and 2010 were included. The abnormal TTM recordings (not including elective replacement indicator) were identified. Logistic regression was used for statistical analysis. Note that P < 0.05 was considered significant.
  
  
  RESULTS
  We identified 186 patients. There were 75 (40%) epicardial systems. The mean age at TTM enrollment was 6.8 ± 5.9 years (2 months-20.2 years). There were 41 (22%) patients with abnormal TTM findings. The abnormalities were found in 23/75 (31%) epicardial and 18/111 (16%) transvenous systems (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.13-4.62, P = 0.02). When controlling for age and presence of heart disease the OR for abnormal transmission in epicardial systems compared with transvenous was 2.1 (95% CI: 1.03-4.43, P = 0.04). Patients with epicardial systems were more likely to have capture abnormalities on TTM than transvenous systems (OR: 6.1, 95% CI: 1.9-19.5, P = 0.002).
  
  
  CONCLUSIONS
  Pediatric patients with epicardial PM systems are more likely to have abnormal TTM test (particularly capture problems) than patients with transvenous systems regardless of age or presence of heart disease. Consequently, patients with epicardial PM systems should be followed closely with TTM.
authors.affiliation: Pediatric Arrhythmia Service, Department of Pediatrics, Morgan Stanley Children's Hospita, Columbia Universit, New York, New York 10032, USA. ll202@columbia.edu
authors.forename: Leonardo
authors.initials: L
authors.lastname: Liberman
authors.forename: Henry M
authors.initials: HM
authors.lastname: Spotnitz
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Hordof
authors.forename: Richard A
authors.initials: RA
authors.lastname: Friedman
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Starc
authors.forename: Eric S
authors.initials: ES
authors.lastname: Silver
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009518:New York / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000706:statistics & numerical data*; D055815:Young Adult