Manchester Heart Centre, Central Manchester University Foundation NHS Trust, Oxford Road, Manchester M13 9WL, UK.
Europace. 2012 Feb;14(2):191-6. doi: 10.1093/europace/eur304. Epub 2011 Oct 11.
Atrial fibrillation (AF) is a major cause of morbidity, mortality, and health resource consumption. However, as many patients with chronic AF are asymptomatic, rapid, accurate opportunistic screening is needed in primary care to detect AF. Conventional electrocardiogram (ECG) technology is too clumsy and time consuming for mass opportunistic screening, thus technology that allows easy, rapid, yet accurate AF screening is required. To address this requirement a prototype hand-held electrode assembly was developed. We hypothesized that a 6-lead frontal-plane ECG acquired from this apparatus in a seated, clothed patient would be as accurate at detecting AF as conventional 12-lead ECG in the undressed, supine patient (the 'gold standard').
Electrocardiograms were obtained from 78 patients with AF and 79 with sinus rhythm (SR). All had a conventional 12-lead ECG, a 6-lead ECG from conventionally positioned limb electrodes, a supine 6-lead recording using the prototype recorder placed on the lower thorax/upper abdomen, and a 6-lead prototype recording in the seated patient, the latter with loosened clothing only. Electrocardiograms were randomly and blindly assessed by two cardiologists for (i) diagnosis of AF vs. SR and (ii) tracing quality (subjectively assessed as good, adequate, or bad). Compared with conventional 12-lead ECG recordings, all 'new' recording methods performed satisfactorily with sensitivities ≥90% (90-99%), specificities ≥94% (94-100%), positive predictive values ≥94% (94-100%), negative predictive values ≥90% (90-99%), and accuracies ≥93% (93-99%). Tracing quality was higher in conventional 12-lead recordings (71 and 80% were assessed as good by the two observers) compared with conventional 6-lead (57 and 59%), supine prototype (41 and 31%), and sitting prototype (39 and 19%).
Despite inferior electrocardiographic quality a 6-lead frontal plane ECG acquired by a simple prototype hand-held electrode assembly allowed reliable differentiation of AF from SR compared with standard 12-lead ECG.
心房颤动（AF）是发病率、死亡率和卫生资源消耗的主要原因。然而，由于许多慢性 AF 患者无症状，因此需要在初级保健中进行快速、准确的机会性筛查以检测 AF。常规心电图（ECG）技术对于大规模机会性筛查来说过于笨拙和耗时，因此需要易于使用、快速且准确的 AF 筛查技术。为了满足这一需求，开发了一种原型手持式电极组件。我们假设，从该设备在坐姿、穿衣患者中获取的 6 导联额面心电图，在未穿衣、仰卧位患者（“金标准”）中检测 AF 的准确性与常规 12 导联 ECG 一样。
对 78 例 AF 患者和 79 例窦性节律（SR）患者进行心电图检查。所有患者均进行常规 12 导联心电图、常规放置的肢体导联 6 导联心电图、使用放置在下胸部/上腹部的原型记录器的仰卧位 6 导联记录以及坐姿患者的 6 导联原型记录，仅穿着宽松的衣服。两名心脏病专家对心电图进行随机、盲法评估，用于（i）诊断 AF 与 SR，以及（ii）迹线质量（主观评估为良好、足够或不良）。与常规 12 导联 ECG 记录相比，所有“新”记录方法的敏感性均≥90%（90-99%）、特异性均≥94%（94-100%）、阳性预测值均≥94%（94-100%）、阴性预测值均≥90%（90-99%）和准确率均≥93%（93-99%）。常规 12 导联记录的迹线质量较高（两名观察者评估为良好的分别为 71%和 80%），而常规 6 导联记录（57%和 59%）、仰卧位原型记录（41%和 31%）和坐姿原型记录（39%和 19%）则较差。
尽管心电图质量较差，但通过简单的原型手持式电极组件获取的 6 导联额面心电图可与标准 12 导联 ECG 相比，可靠地区分 AF 与 SR。
