Single-lead ECGs: the future of home-monitoring in neonatal supraventricular tachycardias

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Supraventricular tachycardia (SVT) is the most common tachyarrhythmia in the neonatal period. Prevalence has not been fully established (up to 1 in 1000 children) and incidence is reported as 1-5% during the first days of life. To date several studies have evaluated in adult population the efficacy and quality of single-lead ECG compared to standard 12-lead ECG. Limited studies are reported in literature in pediatric settings and even less in newborns population. Purpose Primary outcomes of this study are to describe the clinical follow-up of neonatal tachyarrhythmias and to assess parents’ perception of usefulness of single-lead ECG devices. Methods This is a descriptive, cross-sectional and observational study enrolled neonates aged less than 28 days of life with prenatal or postnatal diagnosis of tachyarrhythmia with single-lead ECG home-monitoring, with at least one tracing obtained during follow-up and whose caregiver completed a telephone survey between January 2017 and September 2022 in a Pediatric third-level-Centre. Clinical data and single-lead ECG tracings submitted by parents have been reviewed by two pediatric electrophysiologists. Perception of the usefulness of the device has been assessed through telephone surveys of caregivers. Results Thirty neonates were recruited (57% male, 43% female): 18 (60%) with postnatal and 12 (40%) with prenatal diagnosis. The most reported type of tachycardia was supraventricular in 25 patients (83%), half of them were atrioventricular reentrant tachycardias (AVRT) with 4 cases of Coumel tachycardia and only 2 ventricular tachycardias (VT). Parents submitted a total of 248 single-lead ECG tracings (7% unreadable and 15% with artefacts that didn’t affect the evaluation). 13% (4/30) of the neonates had tachyarrhythmia during home-monitoring: all of these were supraventricular (for a total of 14 tracings evaluated) and were admitted to the Emergency Department (ED) without evidence of hemodynamic decompensation. A variation in medical management (increasing doses of pharmacological treatment or adding another drug) has been needed. 17% (5/30) received accessory pathway ablation during clinical follow-up (2 cases of Coumel tachycardia, 2 cases of AVRT and 1 case of WPW. In the parents’ telephone surveys 72.4% of the them indicated that it was easy to obtain the tracings with the single-lead ECG and 100% to transmit them. 90% perceived a reduction in the need to go to ED and 90% showed increased comfort in managing the arrhythmia. Conclusions Home-monitoring with single-lead ECG is a useful tool for the follow-up of newborns. It allows rapid and reliable recording of heart rhythm and heart rate. It facilitates early diagnosis of tachyarrhythmias in neonates and early therapeutic decisions, provides comfort and reassurance to parents during clinical follow-up. We trust that in the future all neonatal tachyarrhythmias will benefit from this type of home-monitoring.