Telemonitoring with implantable electronic devices in young patients with congenital heart diseases.

AIMS: In paediatric patients with a pacemaker (PM) or an implantable cardioverter defibrillator (ICD) device, interrogation during in-clinic visits is usually required to obtain information on arrhythmias or system failures. An automated telemonitoring system tracking patient- and system-related parameters provides this information on a daily basis and might assist patient management. METHODS AND RESULTS: This retrospective analysis evaluates telemetric data obtained from 48 devices implanted in 45 patients (median age, 12.4 years; range, 5 weeks to 37.6 years) using an automated system [Home Monitoring (HM)] over the last 5 years. Regular transmissions were received on 72% of all days. The event messages and monitoring data of 34 (71%) devices induced system revisions, electrophysiological studies including ablation, programming changes, medication changes, and alterations in sporting activity. Approximately 47% of event messages and 50% of emergency messages arrived within 4 weeks of implantation or latest outpatient visit; 113 (17%) emergency messages reported acute changes in lead parameters or tachycardia, which required medical intervention. In four ICD patients, delivered shocks were unreported and only detected by HM. CONCLUSIONS: An automated telemonitoring system reporting patient- and system-related parameters, generated within the patient's home surrounding, can improve the safety and quality of PM and ICD therapy, especially in children, by allowing early detection of system failure and changes in arrhythmic events.

Vascular interventions in young patients undergoing transvenous pacemaker revision.

AIMS: Transvenous lead implantation for pacemaker (PM) or implantable cardioverter defibrillators systems in children and young patients with congenital heart disease is widely practiced. With longer implantation times, the risk for vascular occlusion increases. Transvenous angioplasty may be used to maintain venous patency for system revision in the future. Retrospective analysis of the interventional techniques employed in our young patients undergoing PM revision may identify its clinical benefit. METHODS AND RESULTS: Between May 2005 and August 2010, 28 procedures to maintain central venous patency were performed in 24 patients. Median age was 14.3 years (range, 3.6-29.5 years). The median lead age at time of intervention was 6.8 years (range, 8 days-21.5 years). Balloon dilation of the stenotic vessels was performed with and without prior lead removal. Revascularization with stent implantation was successfully attempted in all clinically relevant obstructions. All PM systems retained full function or were upgraded as planned. There were no major complications and acute surgical referral was not required. CONCLUSION: Angioplasty techniques may be used to maintain and increase the longevity of transvenous pacing pathways in young patients.

Lead removal in young patients in view of lifelong pacing.

AIMS: In young patients with or without a congenital heart disease, transvenous leads for pacemakers or implantable cardioverter defibrillators can cause later vascular obstruction or infection. Removal of non-functional leads is controversial as it bears the risk of vascular disrupture and embolizations. We report the data of a single centre for paediatric cardiology on efficiency and safety of transvenous lead removal. METHODS AND RESULTS: Between May 2005 and August 2009 in 22 patients with a mean age of 12.9 years (range: 3.6-29.5 years) removal of 28 transvenous leads (mean lead age: 5.1 years) was attempted. The main indications for removal were vascular obstruction, increased threshold, and lead dislocation. Commercially available retraction tools were used, if necessary. Twenty-five leads (89%) were retrieved with clinical success, of which 22 (79%) were removed with complete procedural success. In three leads the lead tips were retained, while three leads could not be retrieved. No major complications occurred. Additional interventions such as recanalization, balloon dilation, or stent implantation were performed as indicated. Procedure and X-ray times could be correlated to the implant age of the leads. CONCLUSION: Using non-electrical techniques, transvenous lead removal can be performed with a success rate of 89% in young patients. In the case of vessel obstructions, lead replacement combined with revascularization should be performed early, as the older the lead, the more prolonged and more hazardous the extraction procedure becomes. The use of new leads and precautionary implantation techniques may facilitate later lead removal.