Miller Nathan, Roelle Lisa, Lorimer Dean, Dalal Aarti S, Orr William B, Van Hare George F, Avari Silva Jennifer N
Electrophysiology Laboratory, St. Louis Children's Hospital, St. Louis, MO, USA.
Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
J Innov Card Rhythm Manag. 2022 Jun 15;13(6):5048-5056. doi: 10.19102/icrm.2022.130605. eCollection 2022 Jun.
Insertable cardiac monitors (ICMs) have undergone advancements in size and functionality over the past decade, resulting in the introduction of small, easily insertable devices capable of long-term remote monitoring. We define first-generation ICMs as implantable cardiac monitoring devices that require an incision and surgical creation of a subcutaneous pocket and second-generation ICMs as devices implanted using a custom-made tool for subcutaneous insertion, respectively. The aim of this study was to understand the differences between first- and second-generation pediatric ICM implants, implant indications, and time to diagnosis. We performed a retrospective, single-center chart review of patients who underwent ICM implantation from 2009-2019, spanning a 5-year course of first-generation ICM implantations and 5-year course of second-generation ICM implantations. Demographic data, past medical history, implant indication, and time to diagnosis were obtained. A total of 208 patients were identified over the 10-year time period, including 38 (18%) who underwent implantation with a first-generation device and 170 (82%) who underwent implantation with a second-generation device. Implant indications for first-generation ICMs included syncope (71%), palpitations (16%), inherited arrhythmia syndrome (IAS) management (5%), and premature ventricular contractions/ventricular tachycardia (VT) (8%); implant indications for second-generation ICMs included syncope (48%), palpitations (19%), IAS management (40%), premature ventricular contractions/VT (11%), atrial fibrillation (2%), tachycardia (3%), and heart block (0.5%). The average time to diagnosis was 38 weeks for patients with first-generation devices and 55 weeks for those with second-generation devices. With innovations in ICM technologies, there are expanding indications for ICM implantation in pediatric patients for long-term monitoring, specifically regarding the management of IAS patients.
在过去十年中，可插入式心脏监测器（ICM）在尺寸和功能方面取得了进展，从而推出了体积小、易于插入且能够进行长期远程监测的设备。我们将第一代ICM定义为需要切开并通过手术创建皮下囊袋的植入式心脏监测设备，将第二代ICM定义为分别使用定制工具进行皮下插入的植入设备。本研究的目的是了解第一代和第二代儿科ICM植入、植入适应症以及诊断时间之间的差异。我们对2009年至2019年接受ICM植入的患者进行了回顾性单中心病历审查，涵盖了5年的第一代ICM植入过程和5年的第二代ICM植入过程。获取了人口统计学数据、既往病史、植入适应症和诊断时间。在这10年期间共识别出208例患者，其中38例（18%）接受了第一代设备植入，170例（82%）接受了第二代设备植入。第一代ICM的植入适应症包括晕厥（71%）、心悸（16%）、遗传性心律失常综合征（IAS）管理（5%）以及室性早搏/室性心动过速（VT）（8%）；第二代ICM的植入适应症包括晕厥（48%）、心悸（19%）、IAS管理（40%）、室性早搏/VT（11%）、心房颤动（2%）、心动过速（3%）和心脏传导阻滞（0.5%）。第一代设备患者的平均诊断时间为38周，第二代设备患者为5周。随着ICM技术的创新，儿科患者ICM植入用于长期监测（特别是关于IAS患者的管理）的适应症正在不断扩大。
