Subject: Children and young adults with a congenital heart disease (CHD) show a wide spectrum of cardiac arrhythmias. With the indication for pacemaker or defibrillator (ICD) implantation, decision has to be made whether an online monitoring system will reliably improve further therapy.
Method: 8 patients (age 4.1 to 37.6, mean 15.5 years) with a congenital heart disease received an implantable device with an integrated homemonitoring facility (Biotronik, Berlin). Follow-up time ranges between 168 and 896 days (mean 457 days, 10 patient years).
Results: In 7 of 8 patients specific event reports were received independently from follow up visits (figure) or perception of any clinically felt symptoms, which led to modification of antiarrhythmic medication, exercise tolerance, electrophysiological catheter ablation or system revision. Data tracking covered 94% of days during follow up. More than 1000 episodes were reported and evaluated. In three patients the reported events were of critical nature (ventricular fibrillation with shock not realised by the patient, lead failure, ventricular tachycardia in a Fontan patient).
Conclusion: Patients with a CHD and progressive arrhythmia and patients with an ICD constitute a high risk group and should be followed as closely as possible. The integrated monitoring system reported decisive data on a daily basis, which led to early modifications of the actual therapy. Additionally it serves to control proper system function. For the patient’s protection the safety and efficacy of the implanted systems are thus controllably improved. The online information system extends medical care especially in our young and active patient population.