Remote monitoring of cardiac implantable devices in children: characteristics and outcome in a retrospective single centre contemporary study. TelePaedia study

Abstract

Abstract Introduction Remote monitoring (RM) has revolutionized implantable cardiac device care in adults. It has demonstrated its safety on hard criteria, a reduction in the number of hospitalizations and emergency room visits, early detection of events and a reduction in inappropriate therapies. However, while pediatric population is becoming emerging, particularly considering congenital heart diseases, there is no contemporary study. Objective The aim of our study was to characterize in our cohort of RM patients the population of children (below 18 yo) implanted with a pacemaker or an ICD and under RM for more than 1 year. Method The data collection was carried out retrospectively within the cohort of RM patients at our university hospital. The outcome combined occurrence of ventricular (VT)/supraventricular (SVT) arrhythmias, appropriate or inappropriate therapies, lead dysfunction/fracture and ERI. Results The study population included 34 patients (17F/17M) with a mean age of 9.4+/-5.8 years (range 0-18 yo) and a mean remote follow-up of 4.6+/-3.9 years (range 1-13 y). The indications for pacing were postoperative atrioventricular block (AVB, n = 9) for operated congenital heart disease or hypertrophic cardiomyopathy (n=1), congenital AVB (n= 5), muscular dystrophy (n = 1) and genetic sinus node dysfunction (n = 1). Indications for an ICD were resuscitated sudden death in hypertrophic cardiomyopathy (n = 4), LQTS (n = 5), CPVT (n = 2), arrhythmogenic right ventricular dysplasia (n = 2), Brugada syndrome (n = 1) and congenital heart disease (n = 2). Pacing devices (n = 17) were mostly implanted with epicardial leads and abdominal box (n = 12). ICDs (n = 18) were implanted in primary (n = 4) or in secondary prevention with epicardial (n = 2)/ endovascular (n=9) /subcutaneous (n = 2) leads depending on children weight and anatomy. One 12 yo-boy had an S-ICD in addition to a previous pacemaker. There were a total of 13 patients with device-triggered alerts: VT in 8 including appropriate therapies in 6 and inappropriate shocks in 2, supraventricular tachycardia in 2, RV lead dysfunction in 2, RV lead fracture in 1 and no alert for ERI. All alerts were treated within 24h. Conclusion This is the first report of cardiac device remote monitoring in a pediatric population. In our population 13/34 patients experienced alerts necessitating intervention over a mean 4.6 year-follow-up. Remote monitoring through device-triggered alerts allowed efficient treatment of an arrhythmic event or a lead dysfunction. This is a preliminary study suggesting the need for further studies on a larger population. Remote monitoring should be considered in all eligible-device children and should be considered as standard of care.