Malloy Lindsey E, Gingerich Jean, Olson Mark D, Atkins Dianne L
University of Iowa Children's Hospital, Iowa City, IA, 52242, USA.
Pediatr Cardiol. 2014 Feb;35(2):301-6. doi: 10.1007/s00246-013-0774-5. Epub 2013 Aug 15.
With the exponential growth of cardiovascular implantable electronic devices (CIEDs) in pediatric patients, a new method of long-term surveillance, remote monitoring (RM), has become the standard of care. The purpose of this study was to determine the usefulness of RM as a monitoring tool in the pediatric population. A retrospective review was performed of 198 patients at the University of Iowa Children's Hospital who had CIEDs. Data transmitted by RM were analyzed. The following data were examined: patient demographics; median interval between transmissions; detection of adverse events requiring corrective measures, including detection of lead failure; detection of arrhythmias and device malfunctions independent of symptoms; time gained in the detection of events using RM versus standard practice; the validity of RM; and the impact of RM on data management. Of 198 patients, 162 submitted 615 RM transmissions. The median time between remote transmissions was 91 days. Of 615 total transmissions, 16 % had true adverse events with 11 % prompting clinical intervention. Of those events requiring clinical response, 61 % of patients reported symptoms. The median interval between last follow-up and occurrence of events detected by RM was 46 days, representing a gain of 134 days for patients followed-up at 6-month intervals and 44 days for patients followed-up at 3 month-intervals. The sensitivity and specificity of RM were found to be 99 and 72 %, respectively. The positive and negative predictive values were found to be 41 and 99 %, respectively. RM allows for early identification of arrhythmias and device malfunctions, thus prompting earlier corrective measures and improving care and safety in pediatric patients.
随着儿科患者心血管植入式电子设备（CIEDs）数量呈指数级增长，一种新的长期监测方法——远程监测（RM）已成为护理标准。本研究的目的是确定RM作为儿科人群监测工具的实用性。对爱荷华大学儿童医院198例植入CIEDs的患者进行了回顾性研究。分析了RM传输的数据。检查了以下数据：患者人口统计学特征；传输之间的中位间隔时间；检测需要采取纠正措施的不良事件，包括检测导线故障；检测与症状无关的心律失常和设备故障；使用RM与标准做法相比在事件检测中节省的时间；RM的有效性；以及RM对数据管理的影响。198例患者中，162例提交了615次RM传输。远程传输之间的中位时间为91天。在615次总传输中，16%有真正的不良事件，其中11%促使临床干预。在那些需要临床反应的事件中，61%的患者报告了症状。RM检测到的事件与最后一次随访之间的中位间隔时间为46天，对于每6个月随访一次的患者，这意味着节省了134天，对于每3个月随访一次的患者，节省了44天。发现RM的敏感性和特异性分别为99%和72%。阳性和阴性预测值分别为41%和99%。RM能够早期识别心律失常和设备故障，从而促使更早采取纠正措施，改善儿科患者的护理和安全性。
