P1090 - Patch versus traditional ambulatory ECG monitoring in children

Intro: Until recently, ambulatory ECG (AECG) monitoring in pediatric patients was
limited to Holter or event monitoring, which pose a unique challenge in this population
due to the cumbersome application of wired leads. Patch AECG monitors offer a
convenient, though more costly, means of ambulatory rhythm assessment in pediatric
patients. The simplicity of application and extended monitoring duration may provide
an advantage over traditional wired AECG devices, but there is little data directly
comparing their clinical impact within the pediatric population.

Methods: This retrospective cohort study included outpatients 0-18 years who
underwent AECG monitoring at our institution in 2011-2017. During this period,
patch AECG monitors were phased in to our clinical practice in 3/2013; traditional
monitors were phased out by 4/2015 (See Figure 1.) A cohort consisting of all patients evaluated
with a Holter or event monitor between 5/2011 - 2/2013 (prior to patch AECG use)
was compared with a time-matched cohort from 5/2015 – 2/2017, when patch
monitors (Zio TM ) were the sole AECG devices used in our practice. Individual chart
review within the electronic medical record determined the clinical impact of all
monitor results

Results: There were 483 AECG monitors reviewed in the two cohorts, with 340
monitors performed in the patch AECG cohort and 143 in the traditional AECG
cohort. Cardiologists prescribed patch monitors at a more frequent rate than
traditional monitors (1 per 11.5 vs 21.8 clinical encounters). The clinical indication
for using the AECG monitors differed in the two cohorts, with patch monitors being
used more often for patient-reported symptoms like palpitations, pre-syncope, or
syncope (38.6% vs 23.8%, p<0.01). Arrhythmia detection rates were similar in both
cohorts, when assessing clinically important results that led to new intervention
(6.2% versus 7.7%, p=0.55) or increased frequency of clinical surveillance (5.0% vs
4.2%, p=0.82). However, patch monitoring more frequently yielded results that
allowed patients to be discharged from cardiology follow-up (46.8% vs 36.8%,
p=0.01). See Table 1 for further details.

Discussion: Within a clinical practice where patients had universal health insurance
coverage, pediatric cardiologists employed patch AECG monitors at a higher rate
than traditional monitors, using them more frequently for patient-reported
symptoms. While there was no difference in the rate of detecting arrhythmias that
escalated clinical management, use of patch AECG monitoring did allow significantly
more patients to be “ruled out” and discharged from cardiology follow-up. Further
cost-effectiveness studies should be undertaken.