Ball Jocasta, Carrington Melinda J, Thompson David R, Horowitz John D, Stewart Simon
Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia Institute of Health, Australian Catholic University, Australia.
Institute of Health, Australian Catholic University, Australia.
Eur J Cardiovasc Nurs. 2015 Oct;14(5):384-94. doi: 10.1177/1474515114547650. Epub 2014 Aug 14.
Atrial fibrillation (AF) is the most common cardiac arrhythmia managed in clinical practice. Maintenance of intended rate or rhythm control following hospitalisation is a key therapeutic goal.
The purpose of this study was to assess post-discharge maintenance of intended AF control and classify potentially predictive heart rate (HR) phenotypes via electrocardiogram (ECG) Holter monitoring.
In a sub-study of a multicentre randomised controlled trial comparing AF-specific management with usual care, 24-hour ECG Holter monitoring was undertaken in 133 patients 7-14 days post-discharge. Intended rate and rhythm control were compared to Holter data. Analysis of the frequency distribution of mean hour-to-hour differences identified those with labile HRs.
Mean age was 71 ± 10 years, 67 (50%) were male and mean HR was 72 ± 14 bpm. Most (89%) had persistent AF (median time in AF=39% (IQR 0-100%)). Uncontrolled HR (>90 bpm for >10% of recording) occurred in 35 (26%) patients and 49 (37%) patients did not achieve their intended rate (n=26) or rhythm control (n=23). Patients in the upper quartile of mean hour-to-hour HR variability were identified as persistently labile (n=33). A further group (n=22) with periodically labile HRs was identified. Those with coronary artery disease (OR 0.34; 95% CI 0.13-0.91, p=0.033) or renal disease/dysfunction (OR 0.24; 95% CI 0.06-0.98, p=0.047) were less likely to demonstrate HR stability (n=78).
Post-discharge ECG Holter monitoring of AF patients represents a valuable tool to identify deviations in intended rhythm/rate control and adjust therapeutic management accordingly. It may also identify individuals who demonstrate labile HRs.
心房颤动（AF）是临床实践中最常见的心律失常。住院后维持预期的心率或节律控制是关键的治疗目标。
本研究的目的是评估出院后预期房颤控制的维持情况，并通过心电图（ECG）动态监测对潜在的预测心率（HR）表型进行分类。
在一项比较房颤特异性管理与常规护理的多中心随机对照试验的子研究中，133例患者在出院后7 - 14天进行了24小时心电图动态监测。将预期的心率和节律控制与动态监测数据进行比较。分析每小时平均差异的频率分布，确定心率不稳定的患者。
平均年龄为71±10岁，67例（50%）为男性，平均心率为72±14次/分钟。大多数（89%）为持续性房颤（房颤中位时间=39%（四分位间距0 - 100%））。35例（26%）患者出现心率控制不佳（记录的>10%时间心率>90次/分钟），49例（37%）患者未达到预期的心率（n = 26）或节律控制（n = 23）。平均每小时心率变异性处于上四分位数的患者被确定为持续性不稳定（n = 33）。还确定了另一组（n = 22）心率周期性不稳定的患者。患有冠状动脉疾病（比值比0.34；95%置信区间0.13 - 0.91，p = 0.033）或肾脏疾病/功能障碍（比值比0.24；95%置信区间0.06 - 0.98，p = 0.047）的患者心率稳定性较差的可能性较小（n = 78）。
对房颤患者出院后进行心电图动态监测是识别预期节律/心率控制偏差并据此调整治疗管理的有价值工具。它还可能识别出心率不稳定的个体。
