Busch Mathias C, Gross Stefan, Alte Dietrich, Kors Jan A, Völzke Henry, Ittermann Till, Werner André, Krüger Anne, Busch Raila, Dörr Marcus, Felix Stephan B
Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
Ann Noninvasive Electrocardiol. 2017 Nov;22(6). doi: 10.1111/anec.12453. Epub 2017 Apr 25.
The clinical relevance of extended monitoring of AF in the general population is unclear. The study evaluated the detection of AF using transtelephonic electrocardiography and the clinical relevance of additional AF findings, especially with regard to stroke risk and mortality.
The data of 1678 volunteers participating in the tele-ECG-subproject of the Study of Health in Pomerania was evaluated. Occurrence of AF as revealed by tele-ECG and conventional ECG was evaluated. Associations with mortality, history of stroke, and other clinical parameters were analyzed.
AF was detected in 21 subjects (1.3%) by conventional ECG (ECG-AF) and in 43 (2.6%) by tele-ECG. All individuals with AF revealed by conventional ECG were also diagnosed to have AF by tele-ECG; 22 were diagnosed by tele-ECG only (Tele-AF). During follow-up (median: 6.3 years) 42/1635, 1/22, and 5/21 participants died in the no-AF-, tele-AF-, and ECG-AF groups (p < .001). Whereas, in comparison to the no-AF group, the risk of death was higher in the ECG-AF group (HR 9.4; 3.7-23.8; p < .001), there was no significant increase in mortality in the tele-AF group (HR 1.9; 0.26-14.0; p = .52). Prevalence of stroke history was higher in the ECG-AF group (19%; 5.5-42%) than with the no-AF (1.9%; 1.3-2.7%; p = .001) and the tele-AF groups (0%; 0-15%; p = .05).
Tele-ECG identifies significantly more AF cases in a population-based setting compared to conventional ECG. The impact of AF diagnosed only by extended monitoring differs from conventionally diagnosed AF. Additional studies are warranted, since this might have an impact on clinical management.
在普通人群中延长房颤监测的临床意义尚不清楚。本研究评估了通过电话心电图检测房颤以及额外房颤发现的临床意义，尤其是关于中风风险和死亡率方面。
对参与波美拉尼亚健康研究的电话心电图子项目的1678名志愿者的数据进行了评估。评估通过电话心电图和传统心电图揭示的房颤发生情况。分析了与死亡率、中风病史和其他临床参数的关联。
通过传统心电图（心电图房颤）在21名受试者（1.3%）中检测到房颤，通过电话心电图在43名受试者（2.6%）中检测到房颤。所有通过传统心电图揭示有房颤的个体通过电话心电图也被诊断为有房颤；22名仅通过电话心电图被诊断（电话房颤）。在随访期间（中位数：6.3年），无房颤组、电话房颤组和心电图房颤组分别有42/1635、1/22和5/21名参与者死亡（p<0.001）。与无房颤组相比，心电图房颤组的死亡风险更高（风险比9.4；3.7 - 23.8；p<0.001），电话房颤组的死亡率没有显著增加（风险比1.9；0.26 - 14.0；p = 0.52）。心电图房颤组中风病史的患病率（19%；5.5 - 42%）高于无房颤组（1.9%；1.3 - 2.7%；p = 0.001）和电话房颤组（0%；0 - 15%；p = 0.05）。
与传统心电图相比，电话心电图在基于人群的环境中能显著识别出更多房颤病例。仅通过延长监测诊断出的房颤的影响与传统诊断的房颤不同。鉴于此可能对临床管理产生影响，有必要进行更多研究。
