A Single-center Experience Comparing First- Versus Second-generation Insertable Cardiac Monitors in Pediatric Patients

Figures

• 

  Figure 1:. First- versus second-generation implantable cardiac monitors (ICMs) implanted by year. This graph represents the absolute number of ICM implants by year, with the blue line demonstrating first-generation ICMs and the orange line demonstrating second-generation ICMs. During the transition year of 2014, when the study institution moved from first- to second-generation ICMs, there were more second-generation ICMs than first-generation ICMs implanted. Also notable is that yearly implants were notably higher with second-generation ICMs.

• 

  Figure 2:. Follow-up of first-generation implantable cardiac monitors (ICMs). A total of 38 first-generation ICMs were implanted between 2009–2014. Of these devices, 55% were explanted, 24% were lost to follow-up, 5% were explanted with a new ICM implanted, and 16% were explanted with an intervention or a new ICM implant with an intervention. The interventions performed included a pacemaker implant, an automatic implantable cardioverter-defibrillator implant, and an electrophysiology study + ablation. Abbreviations: AICD, automatic implantable cardioverter-defibrillator; EPS, electrophysiology study; ICM, insertable cardiac monitor.

• 

  Figure 3:. Follow-up of second-generation implantable cardiac monitors (ICMs). One-hundred seventy second-generation ICMs were implanted between 2014–2019. Of these devices, 38% are currently in place, 24% were explanted, 6% were explanted with a new ICM implanted, 14% were explanted with an intervention (pacemaker implant, automatic implantable cardioverter-defibrillator implant, or electrophysiology study/ablation), 16% were lost to follow-up, and 2% were left in place with an intervention (electrophysiology study/ablation). Abbreviations: AICD, automatic implantable cardioverter-defibrillator; EPS, electrophysiology study; ICM, insertable cardiac monitor.

• 

  Figure 4:. Representative tracings from 3 patients who proceeded to further interventions. A: This 2-year-old girl presented with paroxysmal palpitations and this rhythm was documented during long-term implantable cardiac monitor (ICM) monitoring and an episode of palpitations. The patient was taken to the electrophysiology laboratory and had her supraventricular tachycardia ablated. The ICM was removed during the same procedure. Clinically, the patient has done well since then. B: This 5-year-old girl underwent ICM implantation for infrequent syncope. During ICM remote monitoring, the patient had an episode of syncope and a sinus pause of 3.2 seconds was documented. The device captured the episode as both a symptom-triggered event and an automatic recorded event. The patient was contacted and underwent transvenous single-chamber implantation with ICM removal the following day. C: This 13-year-old boy presented with infrequent exercise-induced syncope and premature ventricular complexes on baseline electrocardiogram and an otherwise normal family history. During this event, the patient had been driving and was stopped by the police for speeding. He had a syncopal event while on the side of…