家庭式心电监测仪在心房颤动患者导管消融术后的随访应用

Comparison of a portable electrocardiographic home monitor device and conventional 24 h holter during the follow-up of the patient after atrial fibrillation ablation

目的 应用传统24 h动态心电图和家庭式心电监测仪掌上心电对同一心房颤动（房颤）射频消融术后患者的心律情况进行随访监测,比较2种随访方式的有效性和依从性.方法 回顾性分析了2015年9月至2016年1月在南京医科大学第一附属医院心血管内科行房颤射频消融的患者共52例,分别同时应用24 h动态心电图和掌上心电随访其术后12个月以内有无房性心律失常事件发生.采用配对χ2检验比较2种随访方式的结果,并计算了2种随访方式的灵敏度、准确度和阴性预测值;通过微信推送并收集《掌上心电使用情况调查问卷》,调查掌上心电的患者使用体验.结果 共入选52例行房颤射频消融的患者,随访期间共收集169份动态心电图和1 218份掌上心电图记录,动态心电图和掌上心电所诊断的房颤射频消融术后房性心律失常发生率分别为20.4％和46.3％,差异具有统计学意义（P=0.004）.掌上心电对房性心律失常事件检测的灵敏度为86.2％,准确度为92.6％,阴性预测值为86.2％,均高于动态心电图.共收到175份《掌上心电使用情况调查问卷》的问卷反馈,大部分患者认为掌上心电更节约时间、性价比更高、更能了解自己病情.结论 掌上心电对房颤患者导管消融术后房性心律失常事件的监测效能优于传统24 h动态心电图,其患者依从性高于24 h动态心电图.

Objective This study was to test the efficacy of a portable electrocardiographic home monitor device（snapECG） in monitoring the patients after atrial fibrillation（AF） ablation procedure,to compare with a conventional 24 h holter,and also to assess patients＇ compliance.Methods Fifty-two patients referred for evaluation of cardiac arrhythmia within 12 months after AF ablation with a conventional 24 h holter monitor and snapECG.Pairedχ2 test was used to assess the agreement of these two follow-up methods.Sensitivity,accuracy and negative predictive value of both methods for the detection of atrial arrhythmia were calculated.One hundred and seventy-five questionnaires were surveyed to evaluate the compliance of 24 h holter and snapECG.Results A total of 169 24 h holter reports and 1 218 episodes of snapECG recordings were obtained.The incidence of atrial arrhythmia were 20.4％ and 46.3％ according to holter and snapECG,respectively（P=0.004）.The sensitivity,accuracy and negative predictive value were higher by snapECG monitor than by conventional 24 h holter.The results of questionnaire revealed that the feasibility and compliance of snapECG were better than 24 h holter.Conclusion The efficacy of snapECG in monitoring patients after AF ablation were better than conventional 24 h holter and the feasibility,and compliance of snapECG were also better than conventional methods.