OBJECTIVE:

To evaluate the impact of telemedicine in diagnosis and management of cardiac arrythmias in children (0-13 years) in Pediatric emergency.

INTRODUCTION:

Telemedicine is defined as diagnosing and treating patients remotely using telecommunications technology. The increased burden of critically ill patients in emergency departments across the country highlights the role of telemedicine which provide remote monitoring of critical patients and assistance to emergency doctor in making accurate diagnosis and effective management of affected patients. Use of telemedicine help determine the abnormal cardiac rhythm and allows early diagnosis and management. Telemedicine is a cost effective way to bridge the gap between primary and secondary health care especially in underprivileged areas.

INCLUSION CRITERIA:

Patients aged 0-13 years who were diagnosed and managed for different cardiac diseases including cardiac arrhythmias after consultation with telemedicine physician.

 EMRs with complete data on diagnosis, treatment and outcome, from November 2023 to May 2025 were included.

MATERIAL&METHODS:

We conducted a retrospective review of EMRs (electronic medical records) of pediatric patients managed in emergency care units supported by child life foundation organization, who were tele-assisted by telemedicine physicians, of “telemedicine unit 1” of child life foundation, for abnormal cardiac rhythms from December 2024 to May 2025.

During consultation telemedicine physicians remotely visualize and monitor patients’ clinical condition. High resolution cameras ensure detailed and continuous monitoring of electrocardiogram. Videoconferencing equipment consist of Voice over Internet Phone (VoIP) and a computer which allows smooth sharing of patient information. Screen sharing is performed by telemedicine physician with cardiology physician working in National Institute of Cardiovascular Disease via Microsoft Teams application.  During consultation patient condition and electrocardiograms were observed and formal medical advice is given by telemedicine physician after consultation with cardiology physician to emergency doctor regarding diagnosis and management

 

 

 

RESULTS:

During the 18 months period (November 2023 t0 May 2025), 255 patients were consulted and tele-assisted by telemedicine physicians for various suspected cardiac diseases (including TET spell, myocarditis, abnormal cardiac rhythms and suspected congenital heart disease.

Out of 255 total consultations, 69 (27%) consultations were done regarding arrhythmias. Most common arrhythmias were supraventricular tachycardia 17(24.6%), heart block 11 (15.9%) sinus tachycardia 9(13%), sinus bradycardia 7(10%). Other abnormal cardiac rhythms identified were ventricular tachycardia 1(1.44%), tall T waves 2 (2.8%) and St Elevation 1(1.4%). No specific ECG changes were observed in rest of consultation 21 (30%) patients. Out of 69 patients who were tele-assisted, 55(79%) patients were further managed and reassessed in pediatric emergency, 2(2.8%) patients were admitted, and 11(15.9%) patients were referred and 1(1.4%) patient was expired. 

 

CONCLUSION:

This study demonstrates effectiveness of telemedicine in diagnosing and managing cardiac arrhythmias in children in pediatric emergency with timely and feasible availability of expert cardiology opinion through telemedicine consultation. This study shows potential reduction in mortality (1.4%) and referral 15.9%) in pediatric emergency. However, further   studies on larger scale with large sample sizes are needed to confirm the findings 

REFERENCES

1. Singh S, et al. (2020). Telemedicine in Pediatric Emergency Care: A Systematic Review. Journal of Telemedicine and Telecare, 26(1), 3-13.
2. Rai S, et al. (2019). Remote Monitoring of Cardiac Arrhythmias: A Review. Journal of Cardiovascular Electrophysiology, 30(11), 2357-2364.
3. Kumar P, et al. (2020). Telemedicine in Pediatric Cardiology: A Review. Pediatric Cardiology, 41(3), 537-545.
4. Gupta A, et al. (2020). Effectiveness of Telemedicine in Emergency Settings: A Systematic Review. Annals of Emergency Medicine, 75(5), 573-583.
5. Patel R, et al. (2022). Telemedicine for Pediatric Cardiac Arrhythmias: A Retrospective Study. Pediatric Emergency Care, 38(2), e621-e625.