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.
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Berul CI, Van Hare GF, Kertesz NJ, Dubin AM, Cecchin F, Collins KK, Cannon BC, Alexander ME, Triedman JK, Walsh EP, Friedman RA (2008) Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart disease patients. J Am Coll Cardiol 51:1685–1991
Ellery S, Pakarashi T, Paul V, Sack S (2006) Predicting mortality and rehospitalization in heart failure patients with home monitoring—the home CARE pilot study. Clin Res Cardiol 95:III/29–III/35
Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NA, Ferguson TB Jr, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD (2013) 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol 61:e6–e75
Fauchier L, Sadoul N, Kouakam C, Briand F, Chauvin M, Babuty D, Clementy J (2005) Potential cost savings by telemedicine-assisted long-term care of implantable cardioverter defibrillator recipients. Pacing Clin Electrophysiol 28:S255–S259
Fox SA, Mackenzie L, Flemming JM, Warren AE (2007) The effectiveness of transtelephonic monitoring of pacemaker function in pediatric patients. Pacing Clin Electrophysiol 30:725–729
Freedberg NA, Feldman A (2014) Remote monitoring of patients with implantable cardioverter defibrillators (ICD): a cute gimmick or an essential tool for clinical excellence? J Cardiovasc Electrophysiol 25:771–773
Guedon-Moreau L, Kouakam C, Klug D, Marquie C, Brigadeau F, Boule S, Blangy H, Lacroix D, Sadoul N, Clementy J, Kacet S (2014) Decreased delivery of inappropriate shocks achieved by remote monitoring of ICD: a substudy of the ECOST trial. J Cardiovasc Electrophysiol 25:763–770
Guedon-Moreau L, Lacroix D, Sadoul N, Clementry J, Kouakam C, Hermida J-S, Aliot E, Kacet S (2014) Costs of remote monitoring vs. ambulatory follow-ups of implanted cardioverter defibrillators in the randomized ECOST study. Europace 16:1181–1188
Hanisch DG, Motonaga KS, Miyake CY, Kirby K, Dubin AM (2013) Heart Rhythm 10: S364
Korte T, Köditz H, Niehaus M, Paul T, Tebbenjohanns J (2004) High incidence of appropriate and inappropriate ICD therapies in children and adolescents with implantable cardioverter defibrillator. Pacing Clin Electrophysiol 27:924–932
Malloy LE, Gingerich J, Olson MD, Atkins DL (2014) Remote monitoring of cardiovascular implantable devices in the pediatric population improves detection of adverse events. Pediatr Cardiol 35:301–306
Marinskis G, Van Erven L, Bongiorni MG, Lip GYH, Pison L, Blomstrom-Lundqvist C (2012) Practices of cardiac implantable electronic device follow-up: results of the European Heart Rhythm Association survey. Europace 14:423–425
Peterson HH, Jensen-Larse MC, Nielsen OW, Kensin F, Svendsen JH (2012) Patient satisfaction and suggestions for improvement of remote ICD monitoring. J Interv Card Electrophysiol 34:317–324
Res JC, Theuns DA, Jordaens L (2006) The role of remote monitoring in the reduction of inappropriate implantable cardioverter defibrillator therapies. Clin Res Cardiol 95:III/17–III/21
Ricci RP, Russo M, Santini M (2006) Management of atrial fibrillation—what are the possibilities of early detection with home monitoring? Clin Res Cardiol 95:III/10–III/16
Vincent JA, Cavitt DL, Karpawich PP (1997) Diagnostic and cost effectiveness of telemonitoring the pediatric pacemaker patient. Pediatr Cardiol 18:86–90
Wilkoff BL, Auricchio A, Brugada J, Cowie M, Ellenbogen KA, Gillis AM, Hayes DL, Howlett JG, Kautzner J, Love CJ, Morgan JM, Priori SG, Reynolds DW, Schoenfeld MH, Vardas PE (2008) HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations. Heart Rhythm 6:907–925
Yee R, Verma A, Beardsall M, Fraser J, Philippon F, Exner DV (2013) Canadian cardiovascular society/Canadian heart rhythm society joint position statement on the use of remote monitoring for cardiovascular implantable electronic device follow-up. Can J Cardiol 29:644–651
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Boyer, S.L., Silka, M.J. & Bar-Cohen, Y. Current Practices in the Monitoring of Cardiac Rhythm Devices in Pediatrics and Congenital Heart Disease. Pediatr Cardiol 36, 821–826 (2015). https://doi.org/10.1007/s00246-014-1090-4
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DOI: https://doi.org/10.1007/s00246-014-1090-4