EPN 2022

Christopher S Snyder

Christopher S Snyder, Speaker at Neonatology Conferences
UH Rainbow Babies & Children’s Hospital, United States
Title : Safety and Efficacy of Unique implantation of Loop Recorder in Pediatric Patients


Insertable cardiac monitors (ICM) allow evaluation of symptom-rhythm correlation. ICMs are commonly used in adults but remain uncommon in pediatric arrhythmia evaluation. Current recommendations call for ICM implant in a diagonal direction on the left anterior chest. Skin tenting and device erosion may occur using this technique, especially in smaller patients.

The purpose was to assess the safety and efficacy of vertical-parasternal device (VP) compared to horizontal (H) implantation of ICM.

Single center, IRB approved retrospective study of pediatric patients that underwent device implantation from 2017-2021. (All device implants were performed under sterile conditions in the electrophysiology laboratory after informed consent.) H cohort had devices inserted per manufacturer recommendations. VP devices were inserted parallel to the sternum, in left chest.  Data collected included demographics, implant orientation (VP or H), complications, device type, presence of P-wave, and measurement of R-wave amplitude at both implantation, as well as follow up. All measurements were confirmed pediatric electrophysiologist. 

ICMs were implanted in 32 patients without congenital heart disease. Fifty-six percent (18) of the cohort were P implantation. All patients in both groups had detectable P-waves at the time of implant. Initial R-wave amplitude average for cohort was 1.00, H cohort was 0.99 (p=NS). Follow-up R-wave amplitude was 1.00 and 0.93 for VP and L (p=NS). Mean age for was 12.5 (1.3-30.5) years and 11.5 (1.1-21.4) years for VP and H (p=NS). 57% of the Horizontal group and 39% VP were under 10 at implantation. VP group had 61% males, while H group was 50% male. There was no significant difference in body surface area at the time of implantation for VP (1.22) and L groups (1.29). Median follow up period for was 7 and 20 months for P and H cohorts (p=NS). H cohort had one periprocedural infection of the ICM pocket. P cohort had no complications.

Parasternal ICM implantation is a safe and effective novel surgical technique. Long-term follow up demonstrates non-inferior R wave detection and no significant signal deterioration, when compared to the currently recommended implantation technique.



Christopher Snyder, MD, is a pediatric cardiologist at UH Rainbow Babies & Children’s Hospital. He joined the UH Rainbow medical staff eight years ago and has served in a number of roles during that time, including Head of Electrophysiology and Executive Committee Member for the hospital. In addition, he is the former KeyBank-Meyer Family Chair for Excellence in Leadership and has previously served as faculty at Yale-New Haven School of Medicine and Ochsner Clinic Foundation.

Dr. Snyder is a graduate of Wayne State University School of Medicine and Baylor College of Medicine. He completed a residency and fellowship at Texas Children’s Hospital with sub-specialty training in pediatric and adult congenital electrophysiology.

With more than 90 peer-reviewed articles and more than 10 book chapters, Dr. Snyder has presented his research at all the major pediatric cardiac meetings in the United States and throughout the world. He is a member of the American Academy of Pediatrics, Heart Rhythm Society, the American College of Cardiology and the American Heart Association. He currently serves as Chair of the Section of Cardiology and Cardiovascular Surgery for the American Academy of Pediatrics and as Chair of the Joint Counsel on Congenital Heart Disease.

During his career, Dr. Snyder has been a member of the Alpha Omega Alpha Honor Medical Society, has been recognized as a Cleveland Best Doctor for the past 8 years and as a Castle Connelly Outstanding Physician. He also received the AAP Recognition of Distinguished Service Award.

He currently serves as a senior editor for Congenital Heart Disease and Case Reports in Cardiology, and editor for the American Journal of Cardiology, The Scientific Pages in Pediatrics and the Journal of Pediatrics and Child Care. He also performs reviews for the PACE, Journal of Invasive Electrophysiology and Pediatrics.