The number of adults with congenital heart disease (ACHD) has progressively increased in recent years to surpass that of children. This population growth has produced a new demand for health care. Moreover, the 2019 coronavirus pandemic has caused significant changes and has underlined the need for an overhaul of healthcare delivery. As a result, telemedicine has emerged as a new strategy to support a patient-based model of specialist care. In this review, we would like to highlight the background knowledge and offer an integrated care strategy for the longitudinal assistance of ACHD patients. In particular, the emphasis is on recognizing these patients as a special population with special requirements in order to deliver effective digital healthcare.
Implantable loop recorders (ILRs) are effective tools for detecting arrhythmias by long-term continuous heart rhythm monitoring. Benefits have been demonstrated even in pediatric patients. ILR with a long sensing vector has recently been designed to improve signal quality in terms of P wave visibility and R wave amplitude. However, there are no data on its use in pediatric patients. We considered a series of pediatric patients implanted with a long sensing vector ILR. Sensing performance, including R wave amplitude and P wave visibility, device-related complications, and diagnostic yield were collected. During follow-up, each patient guided by his/her parents/guardians was also asked to complete a brief questionnaire to assess patient acceptability of the device. Twenty-five consecutive pediatric patients (mean age 11.3 ± 3.5 years, 72% male) were enrolled. The insertion success rate was 100% on the first attempt with no complications. The median amplitude of the R wave was 1.15 mV (interquartile range, 1.01–1.42) with no significant differences between patients aged ≤ or > 10 years (
p
= 0.726) and between female and male (
p
= 0.483). P wave was classified as ‘always visible’ in 24/25 patients (96%). ILR was generally well accepted and tolerated by all involved patients. During a median follow-up of 297 days (117–317), we achieved in 5 patients a correlation between symptoms and rhythm disorders (20%) and ruled out significant arrhythmias in 6 symptomatic children (24%). Long sensing vector ILR showed to be well accepted, with good signal quality and an excellent safety profile even in pediatric patients.
Background: Subcutaneous implantable cardioverter
defibrillators (S-ICD) are widely accepted therapy in congenital heart
disease (CHD) patients at risk of life-threatening ventricular
arrhythmias or sudden cardiac death (SCD) when pacing is not required.
Occasionally, pacemaker (PM) dependent CHD patients will subsequently
develop an indication for a cardioverter defibrillator. The use of S-ICD
in complex CHD who have had already PM devices implanted implies some
specific considerations, as the safety for these patients in unknown and
recommendations among physicians may vary widely. Methods: We
review the data and studied the indications for S-ICD in complex CHD
with previous PM and discuss its usefulness in clinical practice.
Results: From a large cohort of 345 patients enrolled in the
S-ICD “Monaldi care” registry, that encompass all the patients
implanted in the Monaldi Hospital of Naples, we considered 11
consecutive complex CHD patients (10M/1F aged 40.4±18.4 years) who
underwent S-ICD implant after a previous PM implant, from February 2015
to October 2022. Mean follow-up was 23.7±22.5 months. All the patients
showed a good compliance to the device system with no complications
(infections or skin erosions). Conclusions: In complex CHD with
already implanted PM devices, S-ICD implant appears to be a safe
alternative to PM upgrading to transvenous ICD system, avoiding
abandoned leads or life-threatening lead extraction. However, there are
important issues with regards to testing and programming that need to be
addressed at the time of implantation.
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