title: 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.
authors.affiliation: Division of Cardiology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mail Stop #34, Los Angeles, CA, 90027, USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Boyer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silka
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Bar-Cohen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010372:Pediatrics / Q000379:methods; D017410:Practice Guidelines as Topic; D013686:Telemetry / Q000295:instrumentation*; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome