Usefulness of Routine Transtelephonic Monitoring for Supraventricular Tachycardia in Infants

Abstract

Objective: We hypothesize that routine daily transtelephonic monitoring (TTM) transmissions can accurately detect supraventricular tachycardia (SVT) in asymptomatic infants and/or assuage parental concerns rather than being used solely to diagnose arrhythmias.

Study design: Single center, retrospective chart review of 60 patients with fetal or infant SVT prescribed TTM for at least 30 days, January 2010-September 2016. Patients were excluded if initial SVT was not documented, was perioperative, was atrial flutter/fibrillation, or chaotic atrial tachycardia. Categorical variables expressed as mean ± SD. Mann-Whitney, Spearman correlation, and Fisher exact tests were used for continuous and categorical variables respectively.

Results: Sixty patients were included. There were 2688 TTM transmissions received from 55 of 60 patients over 61.1 ± 66.7 days (0.73 ± 0.65 TTM/patient/days). Routine asymptomatic TTM transmissions revealed actionable findings in 5 of 2801 TTM transmissions sent by 5 patients (8.3%). No patient presented in shock or died. Forty-five of 2688 TTM transmissions were sent for parental concerns/symptoms in 16 patients (25.8%) with findings of normal sinus rhythm in 37 of 45 TTM transmissions and SVT in 8 of 45 TTM transmissions. Symptomatic actionable findings were more likely sent by patients discharged on class I or III antiarrhythmics (95% CI = 11.5%-68.3%, P = .004) and patients with prolonged initial hospitalizations (95% CI = 6.98%-59.7%, P = .01). Flecainide was discontinued in 1 patient after widened QRS was noted on routine TTM.

Conclusions: TTM accurately diagnose asymptomatic recurrent SVT in neonates and infants before they develop signs of congestive heart failure or shock and is helpful for recurrent SVT management.

Keywords: antiarrhythmics; asymptomatic; congestive heart failure; symptomatic.