Cardiac implantable electronic device remote monitoring surveillance in pediatric and congenital heart disease: Utility relative to frequency

Abstract

Background: Heart Rhythm Society expert consensus provides recommendations for surveillance monitoring of cardiac implantable electronic devices (CIEDs), but limited data are available for the pediatric and congenital heart disease population.

Objective: The purpose of this study was to determine the rate of actionable events during CIED surveillance in this population, assess the utility of routine CIED remote monitoring, and assess the potential benefit from more frequent monitoring.

Methods: This was a retrospective cohort study of all CIED patients followed at a pediatric and congenital heart center and enrolled in the Medtronic Carelink system with either (1) a chronic (implanted for >6 months) CIED followed between July 1, 2010, and July 1, 2012, on a bimonthly schedule; or (2) a new CIED (implanted <6 months) between July 1, 2008, and July 1, 2012, followed on a monthly schedule.

Results: Aggregate mean age was 20 ± 13.7 years. There were 608 interrogations on newly implanted CIEDs with an actionable event rate of 11 per 100 patient-years. There were 2614 interrogations of chronic CIEDs with an actionable event rate of 22 per 100 patient-years. The odds of an actionable event on an asymptomatic remote monitoring transmission was lower than if symptomatic (odds ratio 0.04, 95% confidence interval 0.03-0.07). Tachyarrhythmia was the most common event. Predictors of actionable events were identified.

Conclusion: In this population of pediatric and congenital heart disease patients, the rate of actionable events was low, especially on asymptomatic interrogations. Most actionable events were due to tachyarrhythmia. A more frequent than every 90-day monitoring schedule does not appear to be of significant benefit.

Keywords: Congenital heart disease; Implantable cardioverter-defibrillator; Pacemaker; Pediatric; Remote monitoring.