DIAGNOSTIC AND COST-EFFECTIVENESS OF TELEMONITORING THE PEDIATRIC PACEMAKER PATIENT

Although recommended as part of a comprehensive pacemaker follow-up pr otocol, the diagnostic and cost-effectiveness of routine telephone mon itoring (TM) in children in the United States is largely unknown. Pati ent age and size with inherent age-related problems and potential inab ility to correlate symptoms with pacemaker performance places the pedi atric patient in a unique category, different from that of the adult. A total of 96 patients, ages 0.2-32.0 years (mean 12.0 years) were fol lowed for 3 years after pacemaker implant with both routine monthly an d anytime emergency TM. A total of 1372 routine transmissions were per formed of a recommended 3456 (40% patient compliance). Of these, 99% s howed normal rhythm or pacemaker function. The remaining 1% demonstrat ed asymptomatic pacemaker dysfunction requiring intervention or new-on set dysrhythmias. A total of 75 emergency transmissions were undertake n for patient/parent-perceived problems, only 8% of which showed pacem aker dysfunction or dysrhythmias. The sensitivity of patient/parent ca pacity to detect pacemaker problems or dysrhythmias based on clinical findings was 29%, with a positive predictive value of 8%. The specific ity of routine monthly TM to screen for asymptomatic pacemaker dysfunc tion or new-onset dysrhythmias was 95%, with a negative predictive val ue of 99%. TM was effective (p < 0.001) for correlating the presence o r absence of pacemaker problems with subjective complaints at any pati ent age. Financial charges for use of TM were significantly less (p < 0.01) than comparable outpatient visits.