Boyer Stacey L, Silka Michael J, Bar-Cohen Yaniv
Division of Cardiology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mail Stop #34, Los Angeles, CA, 90027, USA.
Pediatr Cardiol. 2015 Apr;36(4):821-6. doi: 10.1007/s00246-014-1090-4. Epub 2014 Dec 20.
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.
虽然有针对成人起搏器和植入式心脏复律除颤器（ICD）常规随访的指南，但支持其在儿科和先天性心脏病中适用性的数据极少。本研究旨在确定儿科电生理学家对心脏节律装置（CRD）随访的当前做法。对儿科和先天性电生理学会（PACES）成员进行了调查，内容包括CRD面对面随访的频率以及经电话监测（TTM）和远程监测（RM）的做法。如果使用家庭监测，还评估了其对面对面随访的影响。共有106名PACES成员回复了调查。单纯起搏器和ICD患者的面对面随访中位间隔时间均为6个月（范围1 - 12个月）。67%的回复者使用TTM（中位间隔3个月；范围1 - 6个月），而87%的回复者对起搏器使用RM（中位间隔3个月；范围1 - 6个月），92%的回复者对ICD使用RM（中位间隔3个月；范围2周 - 6个月）。当使用TTM时，21%的回复者减少了起搏器门诊就诊频率。相比之下，RM分别使32%和31%的回复者减少了起搏器和ICD的门诊就诊频率。患者年龄是49%回复者确定CRD随访的独立因素。虽然儿科电生理学家对CRD的随访总体上遵循成人指南，但个体做法差异很大。与成人已发表的建议相反，对于大多数儿科电生理学家而言，TTM和RM的使用并未减少面对面就诊的频率。
