Bethge K P, Gonska B D
Abteilung für Kardiologie und Pulmonologie, Medizinischen Klinik und Poliklinik, Universität Göttingen, BRD.
Wien Med Wochenschr. 1988 Jan 31;138(1-2):5-12.
With the introduction of long-term ECG by N. Holter more than 25 years ago a more sensitive detection of spontaneous arrhythmias and ST-changes became possible compared with the standard ECG at rest. Unfortunately, visual high-speed analysis of the tapes caused remarkable loss of stored informations due to the failure of rapid identification. Full disclosure of the ECG, therefore, is a valuable supplement to long-term ECG. As an isolated method, however, it cannot be recommended since the significantly reduced amplitude and paper speed of full disclosure likewise is responsible for a remarkable loss of informations. Only computer-aided analysis of the ECG provides more complete information and at the same time more quantitative data. Analysis of the accuracy of different computer-based systems showed, however, that a sensitivity as well as a positive predictive accuracy of 100% remains the exception to the rule. Moreover, the spectrum of cardiac arrhythmias and ST-changes identifiable by automatic analysis is small. For these reasons, interaction of the user is mandatory--in order to validate computer results as well as to detect ECG abnormalities unidentifiable by computer. The first is possible only to a limited degree with discontinuous ECG recording by event recorders, the last remains impossible. Thus, the promising concept of real-time cardiac monitors should be considered investigational or experimental at this time.
25年多前N. 霍尔特引入长期心电图后，与静息状态下的标准心电图相比，对自发性心律失常和ST段改变的检测变得更加灵敏。不幸的是，由于快速识别失败，对磁带进行视觉高速分析导致存储信息显著丢失。因此，全信息心电图是长期心电图的一种有价值的补充。然而，作为一种单独的方法，它并不值得推荐，因为全信息心电图显著降低的幅度和纸速同样会导致信息大量丢失。只有计算机辅助的心电图分析才能提供更完整的信息，同时提供更多的定量数据。然而，对不同计算机系统准确性的分析表明，灵敏度和阳性预测准确性达到100%的情况仍然是个例外。此外，通过自动分析可识别的心律失常和ST段改变的范围很小。由于这些原因，用户的交互是必不可少的——以便验证计算机结果以及检测计算机无法识别的心电图异常。对于事件记录仪的间断心电图记录，第一种情况只能在有限程度上实现，而最后一种情况仍然无法做到。因此，实时心脏监测器这个有前景的概念目前应被视为研究性或实验性的。
