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Clinical impact of a novel ambulatory rhythm monitor in children

Published online by Cambridge University Press:  10 July 2018

Joseph W. May ,
Elizabeth L. Carter ,
J. Ryan Hitt  and
Thomas R. Burklow
Joseph W. May*
Affiliation:
Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Elizabeth L. Carter
Affiliation:
Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
J. Ryan Hitt
Affiliation:
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Thomas R. Burklow
Affiliation:
Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
*
Author for correspondence: J. W. May, MD, MPH, Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. Tel: 301 295 4959; Fax: 301 295 5069; E-mail: joseph.w.may6.mil@mail.mil
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Abstract

Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor’s impact in clinical practice. Patients aged 0–18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.

Keywords

Zioambulatory rhythm monitorpatch rhythm monitorchildrenarrhythmia
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 10 , October 2018 , pp. 1134 - 1140
Copyright
© Cambridge University Press 2018 

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