Abstract:
Intro:
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.
Objective:
The purpose was to assess the safety and efficacy of vertical-parasternal device (VP) compared to horizontal (H) implantation of ICM.
Methods:
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.
Results:
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.
Conclusion:
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.
