Safety of Bioelectric Impedance Analysis Testing in Pediatric Patients With Cardiac Implantable Electronic Devices

BACKGROUND: Bioelectric impedance analysis (BIA) is a useful clinical tool in pediatric heart disease, but concerns regarding cardiac implanted electronic devices (CIEDs) limit its use. This study's goal was to assess the impact of BIA on CIED settings in pediatric patients. METHODS: This single-center cohort study included two groups: a retrospective cohort of patients under 21 years old who had CIED interrogation within 12 months before and after BIA use, and a smaller prospective cohort who had CIED interrogation immediately before and after BIA use. The prospective group also underwent real-time monitoring for electrical interference during BIA. Exclusion criteria included age, implanted loop recorders, and incomplete data. Analysis used either a paired t-test or a Wilcoxon signed-rank test as appropriate, with p-value < 0.05 considered statistically significant. RESULTS: The retrospective cohort included 55 patients with 80 total tests. A statistically but not clinically significant difference in lead impedance was observed (513 [456, 627] v 513 [399, 593] ohms, p < 0.0001), though no differences were found in electrogram amplitudes, thresholds, or programmed output. When patients with multiple tests were analyzed, there remained a statistically significant difference in lead impedance (513 [399, 614] v 513 [375, 592] ohms, p = 0.0002) but not in other CIED parameters. In the prospective cohort (n = 10), no electrical interference was appreciated during BIA, and there were no before-and-after differences in CIED sensing amplitudes. No inappropriate shocks or premature device failures occurred. CONCLUSIONS: BIA was not associated with adverse events or meaningful changes in CIED function in this pediatric cohort.