Usefulness of Remote Monitoring of Pediatric Patients with Cardiac Implantable Electronic Devices

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Abstract

Objective: The aim of this study is to evaluate the usefulness of cardiac implantable electronic devices with remote monitoring
system in a pediatric population and the limitations of its implementation in Argentina.

Methods: Twenty-seven patients receiving a cardiac implantable electronic device with remote monitoring system at Hospital
Nacional Garrahan and Hospital Italiano de Buenos Aires were included in the study. The rate of events, complications and
device-related therapies were evaluated. The anticipated actions taken in response to alert notifications were described. Mean
follow-up was 46.6 ± 32.1 months.

Results: Median age was 12.2 years (IQR: 8.75-13.3). An implantable cardioverter defibrillator device was placed in 7 patients (25.9%) and 20 (74%) underwent pacemaker implant. Five patients (18.5%) presented seven red alerts: 3 due to ventricular arrhythmia in monitoring zone of ventricular fibrillation and 4 due to lead dysfunction. Twelve patients (44%) presented a yellow alert: 6 due to lead dysfunction, 4 due to deactivation of the monitoring system because of lack of signal reception, one due to ventricular tachycardia and another with sinus tachycardia in monitoring zone of ventricular tachycardia. Active actions were taken in 9 patients (33.3%) to manage the alert notification: the atrial lead was replaced in one patient and the ventricular in lead in another; in 2 patients non-compliance with pharmacological treatment and exercise limitation were detected and in the rest of the patients, the device was reprogrammed according to the abnormalities observed in the recording or capture.

Conclusions: Remote monitoring of cardiac implantable electronic devices is very useful in the pediatric population, allowing for the rapid detection and management of device failure or significant arrhythmias.