Diagnostic Accuracy and Safety of Confirm Rx™ Insertable Cardiac Monitor in Pediatric Patients

Cardiac implantable electronic devices in pediatric and congenital populations

Pediatric patients and children and adults with congenital heart disease often will require implantation of cardiac implantable electronic devices (CIEDs) for management of a variety of cardiac rhythm pathologies. The safe and effective use of CIEDs in these patients requires an awareness of important differences between this special population and the adult populations for whom these devices were primarily developed and in whom they have been most thoroughly studied. These include issues of body size and growth, anticipated lifespan, anatomical issues related to implantation and the epidemiology of underlying rhythm issues. In this paper, we discuss these issues in the context of the current state of the art in pediatric and congenital heart disease patients with respect to implant and lead extraction strategies, physiological cardiac pacing and resynchronization, ICD indications and use of transvenous and subcutaneous devices, and the use of implantable monitoring devices.

Implantable Loop Recorder with Long Sensing Vector: Safety, Acceptability, and Sensing Performance in Pediatric Patients

Implantable loop recorders (ILRs) are effective tools for detecting arrhythmias by long-term continuous heart rhythm monitoring. Benefits have been demonstrated even in pediatric patients. ILR with a long sensing vector has recently been designed to improve signal quality in terms of P wave visibility and R wave amplitude. However, there are no data on its use in pediatric patients. We considered a series of pediatric patients implanted with a long sensing vector ILR. Sensing performance, including R wave amplitude and P wave visibility, device-related complications, and diagnostic yield were collected. During follow-up, each patient guided by his/her parents/guardians was also asked to complete a brief questionnaire to assess patient acceptability of the device. Twenty-five consecutive pediatric patients (mean age 11.3 ± 3.5 years, 72% male) were enrolled. The insertion success rate was 100% on the first attempt with no complications. The median amplitude of the R wave was 1.15 mV (interquartile range, 1.01-1.42) with no significant differences between patients aged ≤ or > 10 years (p = 0.726) and between female and male (p = 0.483). P wave was classified as 'always visible' in 24/25 patients (96%). ILR was generally well accepted and tolerated by all involved patients. During a median follow-up of 297 days (117-317), we achieved in 5 patients a correlation between symptoms and rhythm disorders (20%) and ruled out significant arrhythmias in 6 symptomatic children (24%). Long sensing vector ILR showed to be well accepted, with good signal quality and an excellent safety profile even in pediatric patients.

Novel Technique for Cardiac Monitor Implantation in Pediatrics

Implantable cardiac monitors (ICM) allow for symptom-rhythm correlation. Current manufacturer recommendations call for implantation of ICMs diagonally in the left anterior chest. Complications such as skin tenting and device erosion have occurred using this technique in pediatric patients. The purpose of this study was to assess the safety and efficacy of implanting ICMs via new vertical-parasternal technique (VP) compared to manufacturer-recommended diagonal technique (D) in pediatric patients. Single-center, IRB-approved retrospective study of pediatric patients that underwent ICM implantation from 01/01/2017 to 12/01/2021. All implants were performed after informed consent, under sterile conditions in the electrophysiology laboratory. Data collected included demographics, implant orientation (VP or D), complications, device type, presence of P-wave, and measurement of R-wave amplitude at implantation and follow-up. ICMs were implanted in 34 patients without congenital heart disease. Initial R-wave amplitude average for VP 1.00, D 0.99 (p = NS). Follow-up R-wave amplitude was 0.97 VP and 0.93 for D (p = NS). Median follow-up period for VP was 11 and for D was 20 months (p = NS). D cohort had only post-procedural complication due to skin tenting of the ICM in child < 2.5 years of age. No skin tenting, erosions, or complications occurred in the vertical-parasternal implant technique. Vertical-Parasternal ICM implantation is as safe and effective as the manufacturer-recommended diagonal implant. Short- and long-term data demonstrate an equivalent R-wave detection and no significant signal deterioration, even in very young children. No skin tenting, erosions, or complications occurred in the vertical parasternal implant technique.