The remote monitoring systems in management of children with Brugada Syndrome: Single center experience

Background: Implementation of remote home monitoring systems (HM) in clinical practice has become undoubtedly an added value for all patients with implantable cardiac devices. The aim of this observational single center study was to investigate the impact of HM in a population of children with Brugada Syndrome (BS) who received an implantable cardioverter defibrillator (ICD) as there are little data about the long term follow-up of children with BS implanted with ICD and no literature is showing the role of HM in managing these patients. Methods: Eleven children (age between 6 months and 18 years) implanted with an ICD were followed either by means of HM and with conventional in-hospital visits in our centre. Alerts received by the HM and/or device related clinical events were recorded, analysed and subsequent clinical decisions were made if needed. Results: During an average observation time of 26 months a total of 16 relevant alerts were recorded in 7 patient of our population (repeated alerts received in three children because of supraventricular tachycardias were excluded from recounting). Only one patient experienced appropriate therapies for life threatening ventricular arrhythmias. Three patients experienced inappropriate therapies due to supraventricular tachycardia and lead dislodgement, importantly the patient were mainly asymptomatic because. By means of HM two patients were discovered to have lead problems because of dislodgement or lead fracture. And one patient was recalled to verify some noises on the ventricular leads that turned out to be external electrical noises. Calculating the anticipation of treatment based on the HM alerts an average anticipation of 76±59 days was showed. Conclusion: Children with an ICD need careful and continuous evaluation because of the high probability for system and arrhythmia-related inappropriate therapies and failures. Remote monitoring systems substantially improve the proper management of children with BS, mainly because in a very young population is also difficult to discriminate the symptomaticity in case of arrhythmias.