Remote monitoring of cardiovascular implantable devices in the pediatric population improves detection of adverse events.
With the exponential growth of cardiovascular implantable electronic devices (CIEDs) in pediatric patients, a new method of long-term surveillance, remote monitoring (RM), has become the standard of care. The purpose of this study was to determine the usefulness of RM as a monitoring tool in the pediatric population. A retrospective review was performed of 198 patients at the University of Iowa Children's Hospital who had CIEDs. Data transmitted by RM were analyzed. The following data were examined: patient demographics; median interval between transmissions; detection of adverse events requiring corrective measures, including detection of lead failure; detection of arrhythmias and device malfunctions independent of symptoms; time gained in the detection of events using RM versus standard practice; the validity of RM; and the impact of RM on data management. Of 198 patients, 162 submitted 615 RM transmissions. The median time between remote transmissions was 91 days. Of 615 total transmissions, 16 % had true adverse events with 11 % prompting clinical intervention. Of those events requiring clinical response, 61 % of patients reported symptoms. The median interval between last follow-up and occurrence of events detected by RM was 46 days, representing a gain of 134 days for patients followed-up at 6-month intervals and 44 days for patients followed-up at 3 month-intervals. The sensitivity and specificity of RM were found to be 99 and 72 %, respectively. The positive and negative predictive values were found to be 41 and 99 %, respectively. RM allows for early identification of arrhythmias and device malfunctions, thus prompting earlier corrective measures and improving care and safety in pediatric patients.
University of Iowa Children's Hospital, Iowa City, IA, 52242, USA.
Lindsey E
LE
Malloy
Jean
J
Gingerich
Mark D
MD
Olson
Dianne L
DL
Atkins
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D019114:Remote Consultation / Q000379:methods; D058998:Remote Sensing Technology / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult