长程动态心电图在卒中患者中诊断心房颤动的临床应用

Clinical application of long-range dynamic electrocardiography in the diagnosis of atrial fibrillation in stroke patients

目的 评价长程动态心电图检查对心房颤动的检出效果,为卒中患者的进一步临床诊疗提供指导。方法 本研究为回顾性研究,收集2020年9月至2021年12月在首都医科大学附属北京天坛医院就诊并完善长程动态心电图检查和24 h动态心电图(Holter)的卒中患者。根据患者心律失常采用的检查方法分为两组:长程动态心电图组和24 h动态心电图组。记录患者监测周期内的心率变化,监测房颤的发生及发作阵数、时间等指标。比较两种检查方法对房颤以及其他心律失常的检出率,并与出院后6个月对已检出的房颤患者进行随访,记录房颤患者的治疗情况及预后。结果 共收集患者数据779例。其中男性患者589(75.61%)例,女性患者190(24.40%)例,平均年龄(56.49±5.158)岁。所有患者采用长程动态心电图检查的平均监测时间(6.44±10.94)d。结果显示,对于不明类型的卒中或短暂性缺血发作(TIA)患者,长程动态心电图房颤检出率优于24 h动态心电图(10.78%比5.78%,P<0.05),在阵发性房颤检出率方面,长程动态心电图组效果也优于24 h动态心电图(9.63%比5.13%,P<0.05)。通过对其他类型心律失常的统计分析发现,长程动态心电图对于窦性停搏(>2 s)(5.65%比0.26%,P<0.01),房性早搏(76.25%比31.32%,P<0.01),房性心动过速(48.14%比19.51%,P<0.01),室性早搏/室早(65.60%比32.99%,P<0.01)的检出率效果优于24 h动态心电图。结论 长程动态心电图在卒中患者中明显提高房颤的检出率。

Objective To investigate the detection effect of long-term dynamic electrocardiogram on atrial fibrillation and provide the guidance for further clinical diagnosis and treatment of stroke patients.Methods The patients with stroke who were treated in Beijing Tiantan Hospital from September 2020 to December 2021 and had conducted long-term dynamic electrocardiogram and 24-hour dynamic electrocardiogram(Holter)were collected.The patients were divided into two groups according to the examination methods used for arrhythmia events:longterm dynamic ECG group and 24-hour dynamic ECG group.The arrhythmia events were recorded during the monitoring period in all the patients;the occurrence of atrial fibrillation,the number and the time of attacks and other indicators were also monitored at the same time.The detection rates of atrial fibrillation and other arrhythmias by the two examination methods were compared;the patients with atrial fibrillation who had been detected were followed up 6 months after discharge;and the treatment and prognosis of the patients with atrial fibrillation were recorded.Results A total of 779 patient data were collected.There were 589(75.61%)male patients and 190(24.40%)female patients,with an average age of(56.49±5.158)years.The average monitoring time of all the patients with long-term Holter monitoring was(6.44±10.94)days.The results of comparing the two methods showed that for the patients with unknown types of stroke or transient ischemic attack(TIA),the detection rate of atrial fibrillation by long-term dynamic electrocardiography was better than that of 24-hour dynamic electrocardiography(10.78%vs.5.78%,P<0.05);in terms of the detection rate of paroxysmal atrial fibrillation,the effect of the long-term dynamic ECG group was also better than that of the 24-hour dynamic ECG(9.63%vs.5.13%,P<0.05).Through the statistical analysis of the other types of arrhythmias,it was found that the long-term dynamic electrocardiogram has a significant effect on sinus arrest(>2 s)(5.65%vs.0.26%,P<0.01),atrial premature beats(76.25%vs.31.32%,P<0.01),atrial tachycardia(48.14%vs.19.51%,P<0.01)and premature ventricular contractions/premature ventricular contractions(65.60%vs.32.99%,P<0.01),better than 24 h Holter monitoring.Conclusion Long-term dynamic electrocardiography could significantly improve the detection rate of atrial fibrillation in the stroke patients.