Bhandari A K, Anderson J L, Gilbert E M, Alpert B L, Henthorn R W, Waldo A L, Cullen M T, Hawkinson R W, Pritchett E L
Heart Institute, Hospital of the Good Samaritan, Los Angeles, CA.
Am Heart J. 1992 Aug;124(2):381-6. doi: 10.1016/0002-8703(92)90601-q.
The purpose of this study was to determine whether symptoms recorded at the time of transtelephonic ECG monitoring (TTEM) correlate with attacks of paroxysmal supraventricular tachycardia (PSVT) or paroxysmal atrial fibrillation (PAF). We studied 113 patients with these arrhythmias who made a total of 3319 TTEM calls during their participation in double-blind, placebo-controlled, crossover, multicenter trials of flecainide therapy. Among 49 patients with PSVT, 62.7% of symptomatic calls were associated with ECG-documented PSVT as compared with 6.8% of asymptomatic calls (p less than 0.001). Similarly, among 69 patients with PAF, 69% of symptomatic calls were associated with ECG-documented PAF compared with 10.6% of asymptomatic calls (p less than 0.001). Both in patients with PSVT and PAF, an attack of PSVT or PAF could be documented by ECG in more than 70% of the calls when patients complained of tachycardia, increased sweating, or dyspnea. The sensitivity of a symptomatic call was 91% for PSVT and 89% for PAF, and it was not influenced by flecainide therapy. However, flecainide therapy was associated with a decrease in the positive predictive value of symptomatic TTEM calls and an increase in false positive TTEM transmissions. We conclude that in patients with symptomatic PSVT or PAF, there is a temporal relationship between symptoms and the occurrence of ECG-documented attacks of PSVT or PAF. However, sole reliance should not be placed on the presence or absence of symptoms as a measure of drug failure or efficacy, and it is important to document the cardiac rhythm by TTEM at the time symptoms are recorded.
本研究的目的是确定经电话心电图监测（TTEM）时记录的症状是否与阵发性室上性心动过速（PSVT）或阵发性心房颤动（PAF）发作相关。我们研究了113例患有这些心律失常的患者，他们在参与氟卡尼治疗的双盲、安慰剂对照、交叉、多中心试验期间共进行了3319次TTEM呼叫。在49例PSVT患者中，有症状呼叫中62.7%与心电图记录的PSVT相关，而无症状呼叫中这一比例为6.8%（p<0.001）。同样，在69例PAF患者中，有症状呼叫中69%与心电图记录的PAF相关，而无症状呼叫中这一比例为10.6%（p<0.001）。在PSVT和PAF患者中，当患者主诉心动过速、出汗增多或呼吸困难时，超过70%的呼叫中可通过心电图记录到PSVT或PAF发作。有症状呼叫对PSVT的敏感性为91%，对PAF为89%，且不受氟卡尼治疗的影响。然而，氟卡尼治疗与有症状TTEM呼叫的阳性预测值降低及假阳性TTEM传输增加有关。我们得出结论，在有症状的PSVT或PAF患者中，症状与心电图记录的PSVT或PAF发作之间存在时间关系。然而，不应仅仅依靠症状的有无来衡量药物的失败或疗效，在记录症状时通过TTEM记录心律很重要。
