Rajakariar Kevin, Koshy Anoop N, Sajeev Jithin K, Nair Sachin, Roberts Louise, Teh Andrew W
Department of Cardiology, Monash University, Eastern Health Clinical School, Victoria, Australia.
Department of Cardiology, Monash University, Eastern Health Clinical School, Victoria, Australia; Department of Cardiology, The University of Melbourne, Austin Hospital Clinical School, Melbourne, Australia.
J Electrocardiol. 2018 Sep-Oct;51(5):884-888. doi: 10.1016/j.jelectrocard.2018.07.008. Epub 2018 Jul 17.
The AliveCor Kardia Mobile (AKM) is a handheld, smartphone based cardiac rhythm monitor that records a lead-I electrocardiogram (ECG). Despite being efficacious for detection of atrial fibrillation (AF), it is unclear whether atrial flutter (AFL) may be misdiagnosed as sinus rhythm due to regular R-R intervals. We hypothesised that generating lead-II tracings through repositioning of the AKM may improve visualisation of flutter waves and clinician diagnosis of AFL compared to traditional lead-I tracings.
A prospective, multi-centre, validation study was conducted comparing standard lead-I AKM positioning with lead-II in AFL. A mixed cohort of lead I tracings from patients in AF and sinus rhythm were also included. Two independent electrophysiologists (EP) analysed all ECGs blinded to the automated device diagnosis.
Fifty patients were recruited, 11 in atrial flutter, 14 in atrial fibrillation, and 25 in sinus rhythm. Lead-I AFL sensitivity was 27.3% for both EP's which individually improved to 72.7% and 54.6% in lead-II. AKM appropriately diagnosed lead-I AFL as unclassified in 18.2% of cases, compared to 54.5% in lead-II. Overall clinician agreement (AF, SR and AFL) was modest utilising AFL lead-I (EP1: κ = 0.71, EP2: κ = 0.73, p < 0.001), which improved with lead-II tracings (EP1: κ = 0.87, EP2: κ = 0.83, both p < 0.001).
Repositioning of the AKM device improves clinician diagnosis of atrial flutter. A lead-II tracing may be considered in high-risk patients to improve detection of atrial flutter.
AliveCor Kardia Mobile（AKM）是一款基于智能手机的手持式心律监测仪，可记录I导联心电图（ECG）。尽管它对检测心房颤动（AF）有效，但由于RR间期规则，尚不清楚心房扑动（AFL）是否可能被误诊为窦性心律。我们假设，与传统的I导联描记相比，通过重新定位AKM生成II导联描记可能会改善扑动波的可视化以及临床医生对AFL的诊断。
进行了一项前瞻性、多中心验证研究，比较了AFL中标准I导联AKM定位与II导联定位。还纳入了房颤和窦性心律患者的I导联描记混合队列。两名独立的电生理学家（EP）在不知道自动设备诊断结果的情况下分析所有心电图。
招募了50名患者，其中11例为心房扑动，14例为心房颤动，25例为窦性心律。两位EP的I导联AFL敏感性均为27.3%，在II导联中分别提高到72.7%和54.6%。AKM将I导联AFL正确诊断为未分类的病例占18.2%，而在II导联中为54.5%。使用AFL I导联时，临床医生的总体一致性（AF、SR和AFL）一般（EP1：κ = 0.71，EP2：κ = 0.73，p < 0.001），而使用II导联描记时有所改善（EP1：κ = 0.87，EP2：κ = 0.83，均p < 0.001）。
重新定位AKM设备可改善临床医生对心房扑动的诊断。对于高危患者，可考虑采用II导联描记以提高心房扑动的检测率。
