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Telemonitoring with implantable electronic devices in young patients with congenital heart diseases
Peter A Zartner1, Nicole Toussaint-Goetz, Joachim Photiadis
1Department of Cardiology, Deutsches Kinderherzzentrum Sankt Augustin, Arnold Janssen Straße 29, D-53757 Sankt Augustin, Germany. p.zartner@asklepios.com
Insights
Automated telemonitoring for pediatric pacemaker and ICD patients improves safety. This system detects system failures and arrhythmia changes early, enhancing therapy quality and patient management.
Area of Science:
- Pediatric cardiology
- Biomedical engineering
- Medical device technology
Background:
- In-clinic interrogation of pacemakers (PM) and implantable cardioverter defibrillators (ICD) is standard for pediatric patients to monitor arrhythmias and device function.
- Automated telemonitoring systems offer daily tracking of patient and device parameters, potentially improving management.
Purpose of the Study:
- To evaluate the utility of an automated telemonitoring system for pediatric patients with PM or ICD devices.
- To assess the system's ability to detect critical events and guide clinical decisions.
Main Methods:
- Retrospective analysis of telemetric data from 48 devices in 45 pediatric patients over 5 years.
- Utilized an automated Home Monitoring (HM) system for data collection.
- Analyzed event messages, monitoring data, and emergency messages.
Main Results:
- Regular transmissions received on 72% of days.
- 34 devices (71%) prompted interventions like system revisions, ablation, or programming changes.
- 113 emergency messages (17%) indicated acute lead or tachycardia issues requiring medical intervention.
- Home Monitoring detected 4 unreported ICD shocks.
Conclusions:
- Automated telemonitoring enhances safety and quality of PM/ICD therapy in children.
- Early detection of system failures and arrhythmic events is facilitated by home monitoring.
- This technology supports improved patient management in pediatric cardiac device patients.
Aims:
In paediatric patients with a pacemaker (PM) or an implantable cardioverter defibrillator (ICD) device, interrogation during in-clinic visits is usually required to obtain information on arrhythmias or system failures. An automated telemonitoring system tracking patient- and system-related parameters provides this information on a daily basis and might assist patient management.
Methods And Results:
This retrospective analysis evaluates telemetric data obtained from 48 devices implanted in 45 patients (median age, 12.4 years; range, 5 weeks to 37.6 years) using an automated system [Home Monitoring (HM)] over the last 5 years. Regular transmissions were received on 72% of all days. The event messages and monitoring data of 34 (71%) devices induced system revisions, electrophysiological studies including ablation, programming changes, medication changes, and alterations in sporting activity. Approximately 47% of event messages and 50% of emergency messages arrived within 4 weeks of implantation or latest outpatient visit; 113 (17%) emergency messages reported acute changes in lead parameters or tachycardia, which required medical intervention. In four ICD patients, delivered shocks were unreported and only detected by HM.
Conclusions:
An automated telemonitoring system reporting patient- and system-related parameters, generated within the patient's home surrounding, can improve the safety and quality of PM and ICD therapy, especially in children, by allowing early detection of system failure and changes in arrhythmic events.
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