Partners for Health NGO, Tbilisi, Georgia.
Telemed J E Health. 2012 Sep;18(7):570-1. doi: 10.1089/tmj.2011.0170. Epub 2012 Jul 24.
As the very first trial of mobile telemedicine in the Republic of Georgia, in June-December 2010 we investigated 35 outpatients with different types of arrhythmia (male/female ratio=16/19; 12-80 years old), among them 5 patients with concomitant epilepsy. The control group comprised 7 clinically healthy sportsmen (soccer players, all men; 15-17 years old), during a 30-min velo ergometer stress test. A three-lead electrocardiogram (ECG) loop recorder (Vitaphone BT 3300; Vitasystems GmbH, Mannheim, Germany) was used in automatic mode, using special LRMA software (MDT, Lázně Bohdaneč, Czech Republic) and a Nokia (Espoo, Finland) model 6730 Symbian phone. Automatically recorded arrhythmia events were transmitted from the loop recorder by Bluetooth(®) (Bluetooth SIG, Inc., Kirkland, WA) to a phone and then by 3G (through our partner mobile operator, MagtiCom Ltd. [Tbilsi, Georgia]) to the Vitasystems server in Germany and were available to Georgian physicians via e-mail/Internet. Arrhythmias were recorded/monitored during 7-68 h of observation. The number of automatically recorded ECG events varied between 3 and 170 per observation, or 0.4-10.7 hourly. Cases of sinus brady- and tachyarrhythmia, sinus node weakness syndrome, atrial fibrillation, supraventricular tachycardia, supraventricular premature complexes, and ventricular premature complexes were correctly recognized by automatic recognition software and recorded. In 3 patients and 1 sportsman previously unspecified (despite multiple investigations), arrhythmias were recorded: paroxysmal tachycardia (n=1), sinus node weakness syndrome (n=1), and ventricular premature complexes (n=2). In 3 cases (all women) light insomnia and nervousness were reported. In 2 patients with neurosis (both elderly men, 1 with epilepsy) we had to stop investigation prematurely because of anxiety/agitation. Mobile telecardiology represents feasible methodology to monitor arrhythmias in outpatients in Georgia, promoting earlier discharge of non-life-threatening cases, improving patients' comfort of life, and increasing their mobility with enhanced safety. Mobile telehealth might also represent significant cost-saving for insurance companies (this is an ongoing study). Finally, in remote areas mobile telemonitoring of patients will improve quality of care by timely provision of a second opinion in cases when local expertise is not sufficient.
作为格鲁吉亚共和国首例移动远程医疗试验，我们在 2010 年 6 月至 12 月期间调查了 35 名患有不同类型心律失常的门诊患者（男女比例=16/19；年龄 12-80 岁），其中 5 名患者伴有癫痫。对照组由 7 名临床健康的运动员（足球运动员，均为男性；年龄 15-17 岁）组成，他们在 30 分钟的踏车测功计应激试验中进行了测试。使用三导联心电图（ECG）循环记录器（Vitaphone BT 3300；Vitasystems GmbH，曼海姆，德国）以自动模式，使用特殊的 LRMA 软件（MDT，拉兹纳博丹尼切，捷克共和国）和诺基亚（芬兰埃斯波）型号 6730 Symbian 手机。自动记录的心律失常事件通过蓝牙（®）（Bluetooth SIG，Inc.，柯克兰，WA）从循环记录器传输到手机，然后通过 3G（通过我们的合作伙伴移动运营商 MagtiCom Ltd. [第比利斯，格鲁吉亚]）传输到德国的 Vitasystems 服务器，并通过电子邮件/互联网提供给格鲁吉亚医生。心律失常在 7-68 小时的观察期间进行记录/监测。每个观察期自动记录的 ECG 事件数量在 3 到 170 个之间，或每小时 0.4-10.7 次。窦性心动过缓/心动过速、窦房结功能障碍综合征、心房颤动、室上性心动过速、室上性早搏和室性早搏等心律失常被自动识别软件正确识别并记录。在 3 名患者和 1 名运动员（尽管进行了多次检查）中记录到以前未发现的心律失常：阵发性心动过速（n=1）、窦房结功能障碍综合征（n=1）和室性早搏（n=2）。在 3 例（均为女性）中，报告出现轻度失眠和紧张。在 2 名神经症患者（均为老年男性，1 名伴有癫痫）中，由于焦虑/烦躁，我们不得不提前停止调查。移动远程心脏病学代表了一种可行的方法，可以监测格鲁吉亚门诊患者的心律失常，促进非危及生命病例的提前出院，提高患者的生活舒适度，并通过提高安全性提高他们的活动能力。移动远程医疗也可能为保险公司节省大量成本（这是一项正在进行的研究）。最后，在偏远地区，通过及时提供第二意见，可以改善患者护理质量，在当地专业知识不足的情况下及时提供意见。
