Turakhia Mintu P, Ullal Aditya J, Hoang Donald D, Than Claire T, Miller Jared D, Friday Karen J, Perez Marco V, Freeman James V, Wang Paul J, Heidenreich Paul A
Department of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
Clin Cardiol. 2015 May;38(5):285-92. doi: 10.1002/clc.22387. Epub 2015 Apr 14.
Identification of silent atrial fibrillation (AF) could prevent stroke and other sequelae.
Screening for AF using continuous ambulatory electrocardiographic (ECG) monitoring can detect silent AF in asymptomatic in patients with known risk factors.
We performed a single-center prospective screening study using a wearable patch-based device that provides up to 2 weeks of continuous ambulatory ECG monitoring (iRhythm Technologies, Inc.). Inclusion criteria were age ≥55 years and ≥2 of the following risk factors: coronary disease, heart failure, hypertension, diabetes, sleep apnea. We excluded patients with prior AF, stroke, transient ischemic attack, implantable pacemaker or defibrillator, or with palpitations or syncope in the prior year.
Out of 75 subjects (all male, age 69 ± 8.0 years; ejection fraction 57% ± 8.7%), AF was detected in 4 subjects (5.3%; AF burden 28% ± 48%). Atrial tachycardia (AT) was present in 67% (≥4 beats), 44% (≥8 beats), and 6.7% (≥60 seconds) of subjects. The combined diagnostic yield of sustained AT/AF was 11%. In subjects without sustained AT/AF, 11 (16%) had ≥30 supraventricular ectopic complexes per hour.
Outpatient extended ECG screening for asymptomatic AF is feasible, with AF identified in 1 in 20 subjects and sustained AT/AF identified in 1 in 9 subjects, respectively. We also found a high prevalence of asymptomatic AT and frequent supraventricular ectopic complexes, which may be relevant to development of AF or stroke. If confirmed in a larger study, primary screening for AF could have a significant impact on public health.
隐匿性心房颤动（AF）的识别可预防中风及其他后遗症。
使用连续动态心电图（ECG）监测筛查AF能够在有已知危险因素的无症状患者中检测出隐匿性AF。
我们使用一种基于可穿戴贴片的设备进行了一项单中心前瞻性筛查研究，该设备可提供长达2周的连续动态ECG监测（iRhythm Technologies公司）。纳入标准为年龄≥55岁且具备以下至少2项危险因素：冠心病、心力衰竭、高血压、糖尿病、睡眠呼吸暂停。我们排除了既往有AF、中风、短暂性脑缺血发作、植入式起搏器或除颤器的患者，或过去一年有心悸或晕厥的患者。
75名受试者（均为男性，年龄69±8.0岁；射血分数57%±8.7%）中，4名受试者（5.3%；AF负荷28%±48%）检测到AF。67%（≥4次心跳）、44%（≥8次心跳）和6.7%（≥60秒）的受试者存在房性心动过速（AT）。持续性AT/AF的联合诊断率为11%。在无持续性AT/AF的受试者中，11名（16%）每小时有≥30次室上性异位复合波。
门诊对无症状AF进行延长ECG筛查是可行的，分别在20名受试者中识别出1例AF，在9名受试者中识别出1例持续性AT/AF。我们还发现无症状AT和频繁室上性异位复合波的患病率较高，这可能与AF或中风的发生有关。如果在更大规模的研究中得到证实，AF的初级筛查可能会对公共卫生产生重大影响。
