Lowres Nicole, Mulcahy Georgina, Gallagher Robyn, Ben Freedman Saul, Marshman David, Kirkness Ann, Orchard Jessica, Neubeck Lis
Sydney Medical School, University of Sydney, Sydney, Australia Sydney Nursing School, University of Sydney, Sydney, Australia Vascular Biology, Anzac Research Institute, Sydney, Australia
North Shore Cardiovascular Education Centre, Royal North Shore Hospital, Sydney, Australia.
Eur J Cardiothorac Surg. 2016 Jul;50(1):44-51. doi: 10.1093/ejcts/ezv486. Epub 2016 Feb 4.
Postoperative atrial fibrillation (POAF) occurs in 25-40% of patients following cardiac surgery, and is associated with a significant increased risk of stroke and mortality. Routine surveillance is not performed post-discharge; however, recurrence of POAF can occur in up to 30% of patients discharged in sinus rhythm. This study aimed to determine the feasibility of patients self-monitoring with an iPhone handheld electrocardiogram (iECG) to identify recurrence of POAF in the post-discharge period following cardiac surgery.
Patients with POAF following cardiac surgery were eligible for participation if they had no prior history of atrial fibrillation (AF) and were discharged home in stable sinus rhythm. Participants were provided with an iECG and asked to record a 30-s iECG, four times per day for 4 weeks post-discharge. iECGs were automatically transmitted to a secure server, and reviewed for the presence of AF by the research team and a validated algorithm. All participants also received brief education on AF.
Forty-two participants completed the intervention (mean age 69 ± 9 years, 80% male). Self-monitoring for POAF recurrence using an iECG was feasible and acceptable, and participants felt empowered. Self-monitoring identified 24% (95% confidence interval, 12-39%) with an AF recurrence within 17 days of hospital discharge. These participants were significantly younger than those without AF recurrence (64 ± 7 vs 70 ± 10 years; P = 0.025), and had a significantly lower CHA2DS2-VASc score (2.3 ± 1.2 vs 3.7 ± 2.3; P = 0.007). However, 80% were at high enough stroke risk to warrant consideration of anticoagulation, i.e. CHA2DS2-VASc score ≥2. Only 30% of recurrences were associated with palpitations. Participation also improved AF knowledge from 6.4 ± 1.8 to 7.3 ± 1.8 (P = 0.02), of a total score of 10.
Providing patients with an iECG is a non-invasive, inexpensive, convenient and feasible way to monitor for AF recurrence in post-cardiac surgery patients. It also provides a mechanism to provide knowledge about the condition and also potentially reduce anxiety. The success of patients using this technology also has implications for extending the use of iECG self-monitoring to other patient groups such as those undergoing antiarrhythmic interventions for AF.
心脏手术后25%-40%的患者会发生术后房颤（POAF），且其与中风和死亡风险的显著增加相关。出院后不进行常规监测；然而，高达30%出院时为窦性心律的患者可能会出现POAF复发。本研究旨在确定患者使用苹果手机手持心电图（iECG）进行自我监测以识别心脏手术后出院期间POAF复发的可行性。
心脏手术后发生POAF且既往无房颤（AF）病史并以稳定窦性心律出院回家的患者符合参与条件。为参与者提供一台iECG，并要求他们在出院后4周内每天记录4次30秒的iECG。iECG自动传输至一个安全服务器，由研究团队和一种经过验证的算法对其进行房颤检查。所有参与者还接受了关于房颤的简短教育。
42名参与者完成了干预（平均年龄69±9岁，80%为男性）。使用iECG对POAF复发进行自我监测是可行且可接受的，参与者感到有掌控感。自我监测发现24%（95%置信区间，12%-39%）的患者在出院后17天内出现房颤复发。这些参与者明显比未出现房颤复发的参与者年轻（64±7岁对70±10岁；P=0.025），且CHA2DS2-VASc评分显著更低（2.3±1.2对3.7±2.3；P=0.00）。然而，80%的患者中风风险足够高，需要考虑抗凝治疗，即CHA2DS2-VASc评分≥2。只有30%的复发与心悸有关。参与还使房颤知识得分从6.4±1.8提高到7.3±1.8（满分10分，P=0.02）。
为患者提供iECG是一种无创、廉价、方便且可行的方法，可用于监测心脏手术后患者的房颤复发。它还提供了一种机制来提供有关该疾病的知识，并可能减轻焦虑。患者使用这项技术的成功也对将iECG自我监测扩展到其他患者群体（如接受房颤抗心律失常干预的患者）具有启示意义。
