P- wave Centric Ambulatory ECG Monitoring in Infants and Young Children

Background: P-wave centric ambulatory ECG monitoring has emerged as an important tool aiding the diagnosis of arrhythmias. However, with no specific pediatric approved ambulatory monitors, efficacy and user experience with these devices in young infants have not been established. Objective: To evaluate tracings quality in children less than 10 kilograms who have been prescribed the P-wave centric Carnation Ambulatory Monitor (CAM) patch by Bardy Diagnostics Inc. Methods: We performed an observational, retrospective study on patients prescribed 48-hour ambulatory Holter monitoring. We aimed to detail our experience with using the CAM patch with a patient population smaller than the recommended weight set forth by Bardy Diagnostics Inc. All patients less than 10 kg who were prescribed a 48-hour CAM patch were included in this review. Additionally, 2 different monitor locations (over the sternum and horizontal over the left axilla) were assessed to address the optimal placement in small children less than 10 kg. Results: A total of 33 CAM reports from 25 patients, aged 0-15 months were included in the study. Mean patient age was 4.2 months {+/-} 5.0 and mean weight was 5.3 kg {+/-} 2.4. Twenty-Four percent of patients (8/33) had known congenital heart disease. Indications for monitoring included: tachyarrhythmia (15/33, 45%), bradycardia (6/33, 18%), ectopic rhythm (9/33, 27%), cardiac tumor (1/33, 1%), and prolonged QT interval (1/33, 1%). All CAM reports showed clear, identifiable P waves which were diagnostic and lead to changes in medical management for 30% of patients (i.e. medication adjustments or discharge from cardiology care). When comparing the P wave between a 12-lead ECG and the CAM patch, 77% of patients had the same or similar P wave morphology to lead aVF. We found the recommended, upright placement over the sternum performed better than the horizontal placement over the left axilla for small infants and children less than 10 kg. Conclusion: A P-wave centric Holter monitor is helpful in providing accurate diagnostics tracings even in infants and small children aiding in their clinical management.