Abstract 16097: Impact of Device Miniaturization on Implantable Loop Recorder Utilization in the Pediatric Population: An Analysis of the Marketscan Database

• Published in: Circulation (New York, N.Y.) Vol. 142; no. Suppl_3 Suppl 3; p. A16097
• Main Authors: Nash, Dustin, Katcoff, Hannah, Faerber, Jennifer, Iyer, Ramesh, O’Byrne, Michael L, Shah, Maully, Janson, Christopher
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 17.11.2020
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_3.16097

IntroductionImplantable loop recorders (ILRs) are an effective technology in the detection of paroxysmal arrhythmias, but utility in the pediatric population has been limited by device size. In 2014, a miniaturized ILR was introduced with a less invasive implant technique. The impact of this technology on ILR utilization in pediatric patients has not been evaluated. HypothesisWe hypothesize an increase in annual pediatric ILR implants since 2014 due to device miniaturization. MethodsA retrospective observational study was conducted using administrative claims from Marketscan Medicaid and Commercial insurance claims databases. Utilization of ILR between 1/2013 and 12/2018 was measured (normalized to the total enrolled population ≤18 years) and compared to two balancing measures (Holter ambulatory monitors and encounters with syncope as a diagnosis). Secondary analyses included evaluations of subsequent interventions and complications. ResultsThe study cohort included 33,532,185 individual subjects, of which 769 underwent ILR implantation. ILR subjects were 52% male, with a median age of 16 years (IQR 10-17 yrs). 71% had a history of syncope, 43% had a history of palpitations, and 28% had a history of congenital heart disease. Utilization of ILR increased in 2014, from 5 procedures per million enrollees in 2013 to 11 per million between 2015-2018, while balancing measures remained static (see Figure).Of 393 subjects with ≥1 year of follow-up post-implant, interventions included catheter ablation in 24 (6%), pacemaker implant in 15 (4%) and ICD implant in 7 (1.8%). Among this group, 14 (3.6%) had a device infection and 5 (1.3%) had an erosion. ConclusionsFollowing introduction of the miniaturized ILR, pediatric utilization has rapidly increased. The effect of this change on outcomes and value deserves further attention.