Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
Heart. 2012 Apr;98(8):645-9. doi: 10.1136/heartjnl-2011-301455. Epub 2012 Mar 7.
Prolonged ECG monitoring is standard for atrial fibrillation (AF) screening. This study investigated whether 7-day event triggered (tECG) ECG recording is equivalent to 7-day continuous Holter (cECG) ECG recording for AF screening.
Both a cECG (Lifecard CF) and a tECG (R.Test Evolution 3) were simultaneously worn for 7 days by patients with known or suspected paroxysmal AF.
In 100 corresponding recordings, median effective duration of monitoring was 165 h (range 10-170 h) for cECG and 137 h (0-169 h) for tECG (p<0.001). Median number and total duration of arrhythmias (AF, atrial flutter or atrial tachycardia) of ≥30 s duration recorded by cECG were 10 (1-428) and 1030 min (≤1-10,020), respectively. An arrhythmia was recorded in 42 cECGs (42%) versus 37 tECGs (37%, p=0.56). Triggered ECG failed to record an arrhythmia in cECG positive cases because of interrupted monitoring in four cases and because of recording failure in one case. Sensitivity, specificity, and positive and negative predictive values of tECG therefore were 88%, 100%, 100%, and 92%, respectively. Quantitative cECG analysis required a median of 20 min (3-205 min) and qualitative tECG analysis 4 min (1-20 min; p<0.001). Skin irritation was a frequent side effect (42%) resulting in premature removal of devices in 16% of patients.
Sensitivity of tECG for AF screening as compared to cECG is lower, mainly because of shorter effective monitoring duration. Qualitative tECG analysis is less time consuming than quantitative cECG analysis. Skin irritation is a frequent side effect and reason for premature device removal.
心电图监测是心房颤动（AF）筛查的标准。本研究旨在探讨 7 天事件触发（tECG）心电图记录是否等同于 7 天连续 Holter（cECG）心电图记录用于 AF 筛查。
通过已知或疑似阵发性 AF 的患者同时佩戴 cECG（Lifecard CF）和 tECG（R.Test Evolution 3），进行 7 天监测。
在 100 份对应记录中，cECG 的中位有效监测时间为 165 h（范围 10-170 h），tECG 为 137 h（0-169 h）（p<0.001）。cECG 记录的≥30 s 持续时间的心律失常（AF、心房扑动或房性心动过速）的中位数数量和总持续时间分别为 10（1-428）和 1030 min（≤1-10,020）。cECG 阳性病例中，42 例（42%）记录到心律失常，37 例（37%）tECG 记录到心律失常（p=0.56）。在 4 例情况下，由于监测中断，在 1 例情况下由于记录失败，触发 ECG 未能记录心律失常。因此，tECG 的敏感性、特异性、阳性预测值和阴性预测值分别为 88%、100%、100%和 92%。定量 cECG 分析需要中位数 20 min（3-205 min），定性 tECG 分析需要 4 min（1-20 min；p<0.001）。皮肤刺激是常见的副作用（42%），导致 16%的患者提前移除设备。
与 cECG 相比，tECG 用于 AF 筛查的敏感性较低，主要是因为有效监测时间较短。定性 tECG 分析比定量 cECG 分析耗时更少。皮肤刺激是一种常见的副作用，也是提前移除设备的原因。
