Velthuis Bob Oude, Bos Jorieke, Kraaier Karin, Stevenhagen Jeroen, van Opstal Jurren M, van der Palen Job, Scholten Marcoen F
Thoraxcenter, Medisch Spectrum Twente, Enschede, The Netherlands.
Ann Noninvasive Electrocardiol. 2013 Nov;18(6):564-70. doi: 10.1111/anec.12075. Epub 2013 Sep 9.
Although atrial fibrillation (AF) is the most commonly encountered arrhythmia, some of the properties make its detection challenging. In daily practice, underdiagnosis can lead to less effective treatment in prevention of stroke. Based on data from studies on treatment of AF, more intensive follow-up strategies, including 7-day Holter recording, 30-day event recording, and even implantable cardiac monitoring devices, are suggested. The study purpose is to evaluate the performance of a continuous single-channel loop recorder with automatic AF detection and transtelephonic electrocardiogram (ECG) transmission capabilities.
A consecutive cohort of 153 patients admitted to the stroke unit with a presumptive diagnosis of ischemic cerebrovascular accident was screened for AF. Twenty-four-hour rhythm observation was performed using a single-channel external loop recorder (ELR) configured for automated AF detection. A total of 45 patients with a known history of AF, AF on the admission ECG, or incomplete registrations were excluded. Extensive additional frequency-based settings were used to establish a reference registration. In total, 2923 recordings were transmitted. We evaluated all events, of which 1190 were designated by the device as AF. The sensitivity, specificity, PPV, and NPV for identifying AF using the ELR were, respectively, 93%, 51%, 5%, and 99%.
In this ELR validation study, the dedicated AF detection algorithm showed to be highly sensitive but not specific for AF. Applicability of an ELR might be limited for efficacious detection of AF, as manual verification is mandatory for a vast amount of recordings.
虽然心房颤动（AF）是最常见的心律失常，但它的一些特性使其检测具有挑战性。在日常实践中，漏诊会导致预防中风的治疗效果欠佳。基于房颤治疗研究的数据，建议采用更密集的随访策略，包括7天动态心电图记录、30天事件记录，甚至植入式心脏监测设备。本研究的目的是评估具有自动房颤检测和经电话心电图（ECG）传输功能的连续单通道环形记录仪的性能。
对153例入住卒中单元、初步诊断为缺血性脑血管意外的患者进行房颤筛查。使用配置为自动房颤检测的单通道外部环形记录仪（ELR）进行24小时心律观察。共有45例有房颤病史、入院心电图显示房颤或记录不完整的患者被排除。使用广泛的基于频率的额外设置来建立参考记录。总共传输了2923份记录。我们评估了所有事件，其中1190份被设备判定为房颤。使用ELR识别房颤的敏感性、特异性、阳性预测值和阴性预测值分别为93%、51%、5%和99%。
在这项ELR验证研究中，专用的房颤检测算法对房颤显示出高度敏感性，但缺乏特异性。由于大量记录需要人工验证，ELR在有效检测房颤方面的适用性可能有限。
