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植入式心脏监测器是房颤检测的“金标准”吗?一项前瞻性随机试验,比较房颤消融术后患者使用植入式心脏监测器和DDDRP永久起搏器进行房颤监测的情况。

Are implantable cardiac monitors the 'gold standard' for atrial fibrillation detection? A prospective randomized trial comparing atrial fibrillation monitoring using implantable cardiac monitors and DDDRP permanent pacemakers in post atrial fibrillation ablation patients.

作者信息

Podd Steven J, Sugihara Conn, Furniss Stephen S, Sulke Neil

机构信息

Cardiology Research Department, East Sussex Healthcare NHS Trust, Eastbourne Gen Hospital, East Sussex, UK.

Cardiology Research Department, East Sussex Healthcare NHS Trust, Eastbourne Gen Hospital, East Sussex, UK

出版信息

Europace. 2016 Jul;18(7):1000-5. doi: 10.1093/europace/euv367. Epub 2015 Nov 18.

Abstract

AIMS

Implantable devices are widely accepted, but not proven, to be the most reliable monitoring method to assess atrial fibrillation (AF) therapies. We compared REVEAL(®)XT implantable cardiac monitors (ICMs) and permanent pacemakers (PPMs).

METHODS AND RESULTS

Fifty patients with paroxysmal AF were randomized to ICM or PPM implant 6 weeks prior to pulmonary vein isolation. Permanent pacemakers were programmed to monitoring only (ODO). Device downloads were performed at 0, 3, 6, 9, and 12 months. All patients underwent 7-day external loop recorder. Device ECGs and EGMs were compared for AF burden. A total of 20 744 and 11 238 arrhythmia episodes were identified in the ICM and PPM groups, respectively. Correct identification of AF was significantly better in the PPM group (97 vs. 55% P < 0.001). In the ICM group, 26% of ECGs were un-interpretable. Sensitivity and specificity for each episode of AF was significantly better in the PPM group (100 vs. 79% and 98 vs. 66%, respectively, P < 0.001). The positive predictive value for the detection of any AF was significantly better in the PPM than the ICM (100 vs. 58%, P = 0.03). The negative predictive value for the absence of all AF was not significantly different between the PPM and ICM (100% vs. 92%, P = 0.76).

CONCLUSION

Permanent pacemakers Holters are the most accurate method of evaluating arrhythmia burden and the therapeutic efficacy of novel AF therapies. ICM has a high degree of artefact, which reduces its specifity and sensitivity. Despite the deficiencies of ICM monitoring the negative predictive value of the ICM is satisfactory if zero AF burden is the aim of therapy.

摘要

目的

可植入设备被广泛接受,但尚未被证明是评估房颤(AF)治疗最可靠的监测方法。我们比较了REVEAL(®)XT植入式心脏监测器(ICM)和永久性起搏器(PPM)。

方法与结果

50例阵发性房颤患者在肺静脉隔离术前6周被随机分配接受ICM或PPM植入。永久性起搏器被设置为仅监测模式(ODO)。在0、3、6、9和12个月时进行设备数据下载。所有患者均接受7天的体外循环记录仪监测。比较设备心电图(ECG)和心内心电图(EGM)的房颤负荷。ICM组和PPM组分别共识别出20744次和11238次心律失常发作。PPM组对房颤的正确识别率显著更高(97%对55%,P<0.001)。在ICM组中,26%的心电图无法解读。PPM组对每次房颤发作的敏感性和特异性显著更高(分别为100%对79%和98%对66%,P<0.001)。PPM检测任何房颤的阳性预测值显著优于ICM(100%对58%,P = 0.03)。PPM和ICM在无所有房颤的阴性预测值方面无显著差异(100%对92%,P = 0.76)。

结论

永久性起搏器动态心电图是评估心律失常负荷和新型房颤治疗疗效的最准确方法。ICM有高度伪差,降低了其特异性和敏感性。尽管ICM监测存在缺陷,但如果治疗目标是零房颤负荷,ICM的阴性预测值是令人满意的。

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