Unmasking paediatric tachycardias at home: applicability of the AliveCor outpatient ECG monitor for clinical management of neonates and infants with tachyarrhythmias

Abstract

BACKGROUND: Up to 1 in 250 to 1000 children suffer from supraventricular tachycardia, the most common heart rhythm disturbance in the paediatric population. The clinical presentation in infants is non-specific and obtaining the correct diagnosis is further complicated due to most arrhythmias are paroxysmal, making it difficult to capture the abnormal rhythm on an ECG during an outpatient visit. If tachyarrhythmia is correctly identified in a timely manner, most children will lead a healthy live, but if prolonged or misdiagnosed episodes occur, they may develop congestive heart failure. The constant progress of biotechnology is profoundly changing the practice of medicine and

the way healthcare decisions are made. The development of a smartphone application to record a high-quality single- lead ECG with the aid of a device such as AliveCorâ, makes outpatient monitoring more accessible to these patients.

At the same time, it is helpful for timely diagnosis and rapid management of tachyarrhythmia reducing overall morbidity and facilitating parental reassurance.

HYPOTHESIS AND OBJECTIVES: The hypothesis was that remote monitoring by AliveCorâ Kardia Mobile single- lead ECG device was a useful tool for outpatient monitoring of paediatric patients under 3 years old at the time of

diagnosis of tachyarrhythmia. The aim of this project was to analyse demographic data and clinical characteristics of the patients and describe the electrocardiographic features of single-lead ECG recordings obtained with AliveCorâ device. Also, to assess and describe the parental perception of the usefulness of AliveCorâ monitoring. METHODS: A descriptive, cross-sectional, observational and retrospective study was designed with a total sample of 30 anonymized patients with prenatal or postnatal diagnosis of tachyarrhythmia and outpatient monitoring with AliveCorâ managed in HSJD. Patient demographics and clinical data were observed to assess the applicability of AliveCorâ in paediatric patients with great variability. The tracings obtained with AliveCorâ have been thoroughly read and analysed. The parental perception was determined by means of a survey. RESULTS: A total of 190 tracings obtained with AliveCorâ were analysed. 5% of the tracings were considered as non-legible and 13,7%-17,4% had artifacts. 19 tracings with tachyarrhythmia were detected during the follow-up, (6 wide QRS, 13 narrow QRS). During AliveCorâ monitoring, 7 patients (23,3%) had to attend the emergency department to manage the tachyarrhythmia detected. In none of these cases the patient became haemodynamically decompensated. Changes in chronic management were made in 50% of patients during the follow-up, of which 40% increased and 60%, reduced treatment. 29 parent surveys were completed. 72,4% of the survey responses indicated that it was easy to obtain tracings and the 100% to transmit them. By having the device, 89,7% reduced the need to visit the emergency department, 89,6% showed added comfort in managing arrhythmia, 86,2% reported reinforcement in medical surveillance and 93,1% in the accessibility to the specialist. CONCLUSIONS: Our results conclude that AliveCorâ monitoring is a useful tool for outpatient monitoring of paediatric patients under 3 years old at the time of tachyarrhythmia diagnosis. AliveCorâ recorded the heart rate and rhythm of paediatric patients quickly and reliably. Parents felt that the device provided greater reassurance, promoted rapid and effective assessment by the specialist and enabled early therapeutic decisions, often saving visits to the emergency department