title: Cardiac implantable electronic device remote monitoring surveillance in pediatric and congenital heart disease: Utility relative to frequency.
abstract: BACKGROUND
  Heart Rhythm Society expert consensus provides recommendations for surveillance monitoring of cardiac implantable electronic devices (CIEDs), but limited data are available for the pediatric and congenital heart disease population.
  
  
  OBJECTIVE
  The purpose of this study was to determine the rate of actionable events during CIED surveillance in this population, assess the utility of routine CIED remote monitoring, and assess the potential benefit from more frequent monitoring.
  
  
  METHODS
  This was a retrospective cohort study of all CIED patients followed at a pediatric and congenital heart center and enrolled in the Medtronic Carelink system with either (1) a chronic (implanted for >6 months) CIED followed between July 1, 2010, and July 1, 2012, on a bimonthly schedule; or (2) a new CIED (implanted <6 months) between July 1, 2008, and July 1, 2012, followed on a monthly schedule.
  
  
  RESULTS
  Aggregate mean age was 20 ± 13.7 years. There were 608 interrogations on newly implanted CIEDs with an actionable event rate of 11 per 100 patient-years. There were 2614 interrogations of chronic CIEDs with an actionable event rate of 22 per 100 patient-years. The odds of an actionable event on an asymptomatic remote monitoring transmission was lower than if symptomatic (odds ratio 0.04, 95% confidence interval 0.03-0.07). Tachyarrhythmia was the most common event. Predictors of actionable events were identified.
  
  
  CONCLUSIONS
  In this population of pediatric and congenital heart disease patients, the rate of actionable events was low, especially on asymptomatic interrogations. Most actionable events were due to tachyarrhythmia. A more frequent than every 90-day monitoring schedule does not appear to be of significant benefit.
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan. Electronic address: brynnd@umich.edu.
authors.forename: Brynn E
authors.initials: BE
authors.lastname: Dechert
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Serwer
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Macdonald
authors.initials: M
authors.lastname: Dick
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: LaPage
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation; D010138:Pacemaker, Artificial; D058998:Remote Sensing Technology; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Congenital heart disease; Implantable cardioverter-defibrillator; Pacemaker; Pediatric; Remote monitoring