Miniaturized Implantable Loop Recorder in Small Patients: An Effective Approach to the Evaluation of Subjects at Risk of Sudden Death.

BACKGROUND: The etiological diagnosis of syncope and/or palpitations in children is often challenging. However, when noninvasive conventional examinations are inconclusive, the subcutaneous miniaturized implantable loop recorder (ILR) is recommended. The aim of our study was to evaluate the efficacy of miniaturized cardiac implantable devices in the early diagnosis of arrhythmias in children ≤6 years. METHODS: From March 2014 to May 2015, 21 patients (median age 5 years) underwent implantation of miniaturized ILR at our Institution after a complete cardiac work up. Median follow-up was 10 months. RESULTS: One patient underwent device removal for pocket infection and one needed a pocket revision. Eleven (52%) patients did not show any symptom and/or arrhythmia. Eight patients experienced symptoms during ILR monitoring: six had no electrocardiographic abnormalities, two had significant sinus pauses. Two patients had significant arrhythmias without symptoms and in one of these a pacemaker was implanted. The overall diagnostic yield was 47%. CONCLUSIONS: Miniaturized ILR could be very useful to make a diagnosis and to decide future management strategies in small patients with undefined symptoms or severe cardiac diseases. Considering its characteristics, miniaturized ILR could start a new era in the diagnosis and follow-up of young patients with symptomatic and/or malignant arrhythmias.

Results of remote follow-up and monitoring in young patients with cardiac implantable electronic devices.

BACKGROUND: Remote monitoring is increasingly used in the follow-up of patients with cardiac implantable electronic devices. Data on paediatric populations are still lacking. The aim of our study was to follow-up young patients both in-hospital and remotely to enhance device surveillance. METHODS: This is an observational registry collecting data on consecutive patients followed-up with the CareLink system. Inclusion criteria were a Medtronic device implanted and patient's willingness to receive CareLink. Patients were stratified according to age and presence of congenital/structural heart defects (CHD). RESULTS: A total of 221 patients with a device - 200 pacemakers, 19 implantable cardioverter defibrillators, and two loop recorders--were enrolled (median age of 17 years, range 1-40); 58% of patients were younger than 18 years of age and 73% had CHD. During a follow-up of 12 months (range 4-18), 1361 transmissions (8.9% unscheduled) were reviewed by technicians. Time for review was 6 ± 2 minutes (mean ± standard deviation). Missed transmissions were 10.1%. Events were documented in 45% of transmissions, with 2.7% yellow alerts and 0.6% red alerts sent by wireless devices. No significant differences were found in transmission results according to age or presence of CHD. Physicians reviewed 6.3% of transmissions, 29 patients were contacted by phone, and 12 patients underwent unscheduled in-hospital visits. The event recognition with remote monitoring occurred 76 days (range 16-150) earlier than the next scheduled in-office follow-up. CONCLUSIONS: Remote follow-up/monitoring with the CareLink system is useful to enhance device surveillance in young patients. The majority of events were not clinically relevant, and the remaining led to timely management of problems.

Designing effective partnerships for waste-to-resource initiatives: Lessons learned from developing countries.

Cities in developing countries across Asia-Pacific are struggling to effectively manage municipal solid waste (MSW). This is especially the case in secondary cities and small towns, which often face a lack of resources and know-how. Because the waste stream in these cities is usually high in organic content (50-80%) and recyclable materials (10-20%), waste-to-resource initiatives are viable options for sustainable MSW management. Waste-to-resource initiatives that are low-cost, low-tech, decentralised and community-based offer municipalities useful solutions for managing their MSW. However, the sustainability of such solutions depends on a number of key factors, such as the separation of waste at source, the effective engagement of communities and steady and predictable sources of revenue. Using quantitative data and qualitative information derived from field experience, this paper concludes that effective partnerships between a diverse range of stakeholders must be designed and fostered in order to achieve sustainability. The paper provides an analysis of stakeholder roles for the establishment of effective partnerships in four case study cities of Matale and Ratnapura (Sri Lanka) and Kon Tum and Quy Nhon (Viet Nam), where waste-to-resource facilities have been established, and explores the resources of stakeholders and how these can be mobilised to support waste-to-resource initiatives for revenue generation and long-term sustainability.