UH Rainbow First in the U.S. to Implant Smartphone-enabled Cardiac Monitor in a Pediatric Patient

UH Harrington Heart & Vascular Innovations – Summer 2018

Chris Snyder, MD

Unexplained syncopal episodes and sporadic heart arrhythmias are a challenge for pediatric electrophysiologists. Parents and their children are anxious for answers, which a physical examination, ECG and traditional Holter monitoring may not provide.

“If you put a monitor on for 24 hours and then take it off, chances are the child will have the episode in the 25th hour and you won’t capture it,” says Chris Snyder, MD, Chief of Pediatric Cardiology at University Hospitals Rainbow Babies & Children’s Hospital. “It’s also hard to capture these episodes when a child passes out unexpectedly.”

To get around these problems, the pediatric cardiology team at UH Rainbow is now using a smartphone-compatible implantable cardiac monitor in some patients. The group was the first in the United States to use the Confirm Rx monitor in a pediatric patient in November 2017.

“The Bluetooth-enabled cardiac monitor is paired with the patient’s cellphone, through an app,” Dr. Snyder says. “If you are having an episode, you pull up the app on your phone and report it. The cellphone uploads the electrophysiology data from the cardiac monitor and sends it to the cloud. Within 30 seconds, it’s on my phone and I can call the patient immediately. It’s phenomenal.”

Dr. Snyder and his team have used the Confirm Rx monitor in six pediatric patients to date.

“When I see a child who complains of their heart beating fast, we use a non-invasive monitor first,” he says. “If we can’t figure it out, we talk to the family about having one of these implantable devices put in. In about six out of 10 cases, we’re able to figure it out with the non-invasive monitor, either the one-day Holter, the 14-day or 30-day monitor. For the ones that we can’t capture their rhythm or the child who has an unexplained episode of syncope, the implantable monitor is a great option.”

In addition to allowing patients to report episodes, the implantable Confirm Rx monitor allows Dr. Snyder and his team to review the data collected for any episodes the patient might have missed.

“We use a routine device interrogator that we use for pacer and defibrillators, and it can communicate with the device also,” he says. “This helps us know for sure whether the patient missed anything or had an event that didn’t meet the criteria that we set on the device for arrhythmia detection. The device is also interrogated by a home monitor every day. At least once a day and oftentimes twice a day, the device will talk to the device, searching it for any rhythm issues the patient failed to recognize. We had one patient who didn’t know they had had an episode, but the device picked it up and sent it to us.”

The procedure to implant the Confirm Rx monitor is simple and quick, Dr. Snyder says. A small loading device inserts the monitor just under the skin, through a small incision just left lateral of the sternum, between the fourth and fifth rib.

“It’s super-easy and super-quick,” he says. “This is a game-changer in the world of pediatric electrophysiology. Older devices used to be the size of my thumb. Now these things are the size of a pen cap. They go in in three or four minutes. I’ve never had a patient have a problem.”

For Dr. Snyder, the main advantages of the Confirm Rx monitor are its unique diagnostic niche and the rapid response it allow for members of his team.

“We get the data right away,” he says. “If the child is in any kind of danger, we know it immediately. We can easily alert the family, whether they’re on a camping trip or at the mall. That makes it fantastic.”

But he thinks the implantable monitor has other, less tangible benefits as well.

“Kids love having the ability to monitor their own heart rhythm,” he says. “This puts them in charge. We’re empowering them to take charge of their own healthcare. The younger generation enjoys that, they look forward to it. That’s why this device is absolutely fantastic for pediatrics.”