Spentzou Georgia, Mayne Kaitlin, Fulton Helen, McLeod Karen
Department of Paediatric Cardiology, Royal Hospital for Children, Queen Elizabeth University Hospitals, Glasgow, Lanarkshire G51 4TF, UK.
Cardiol Young. 2019 Oct;29(10):1243-1247. doi: 10.1017/S1047951119001823. Epub 2019 Sep 2.
There is growing interest in the use of digital medicine to reduce the need for traditional outpatient follow-up. Remote interrogation of pacemakers and implantable cardioverter defibrillators is now possible with most devices. The aim of our study was to evaluate the safety and efficacy of virtual pacing clinics in following up children with pacemakers and implantable cardioverter defibrillators, including epicardial systems.
The study was retrospective over 8 years (2010-2017), with review of patient records and analysis of downloads from the implantable cardiac devices to the virtual clinics.
A total of 75 patients were set up for virtual clinic follow-up during the study period, 94.5% with a pacemaker and 5.5% an implantable cardioverter defibrillator. The majority (76.8%) had an epicardial system. Data on lead impedance, battery longevity, programmed parameters, detected arrhythmias, percentage pacing and delivered defibrillator therapies were obtainable by download. Lead threshold measurements were obtainable via download in 83.7% of the devices, including epicardial systems. No concerning device issue was missed. In 15% of patients a major issue was detected remotely, including three patients with lead fractures. The virtual clinics resulted in fewer hospital attendances while enhancing monitoring and enabling more frequent device checks. The vast majority (91.4%) of families who responded to a questionnaire were satisfied with the virtual clinic follow-up.
Virtual clinics allow safe and effective follow-up of children with pacemakers and implantable cardioverter defibrillators, including those with epicardial systems and are associated with high levels of parent satisfaction.
人们越来越关注使用数字医学来减少传统门诊随访的需求。现在，大多数设备都可以对起搏器和植入式心脏复律除颤器进行远程询问。我们研究的目的是评估虚拟起搏诊所对植入起搏器和植入式心脏复律除颤器（包括心外膜系统）的儿童进行随访的安全性和有效性。
该研究回顾了8年（2010 - 2017年）的数据，查阅了患者记录，并分析了从植入式心脏设备下载到虚拟诊所的数据。
在研究期间，共有75名患者被安排进行虚拟诊所随访，其中94.5%植入起搏器，5.5%植入植入式心脏复律除颤器。大多数（76.8%）患者有心外膜系统。通过下载可获得有关导线阻抗、电池寿命、程控参数、检测到的心律失常、起搏百分比和除颤器治疗次数的数据。83.7%的设备（包括心外膜系统）通过下载可获得导线阈值测量值。没有遗漏任何有关设备的问题。在15%的患者中，通过远程检测到了重大问题，包括3名导线骨折的患者。虚拟诊所减少了患者的医院就诊次数，同时加强了监测并能更频繁地进行设备检查。绝大多数（91.4%）回复问卷的家庭对虚拟诊所随访感到满意。
虚拟诊所能够对植入起搏器和植入式心脏复律除颤器的儿童（包括有心外膜系统的儿童）进行安全有效的随访，并且家长满意度很高。
