Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia.
BMJ Open. 2018 Sep 17;8(9):e024178. doi: 10.1136/bmjopen-2018-024178.
Recent technology advances have allowed for heart rhythm monitoring using single-lead ECG monitoring devices, which can be used for early diagnosis of atrial fibrillation (AF). We sought to investigate the AF detection rate using portable ECG devices compared with Holter monitoring.
SETTING, PARTICIPANTS AND OUTCOME MEASURES: We searched the Medline, Embase and Scopus databases (conducted on 8 May 2017) using search terms related to AF screening and included studies with adults aged >18 years using portable ECG devices or Holter monitoring for AF detection. We excluded studies using implantable loop recorders and pacemakers. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to explore potential sources for heterogeneity. Quality of reporting was assessed using the tool developed by Downs and Black.
Portable ECG monitoring was used in 18 studies (n=117 436) and Holter monitoring was used in 36 studies (n=8498). The AF detection rate using portable ECG monitoring was 1.7% (95% CI 1.4 to 2.1), with significant heterogeneity between studies (p<0.001). There was a moderate linear relationship between total monitoring time and AF detection rate (r=0.65, p=0.003), and meta-regression identified total monitoring time (p=0.005) and body mass index (p=0.01) as potential contributors to heterogeneity. The detection rate (4.8%, 95% CI 3.6% to 6.0%) in eight studies (n=10 199), which performed multiple ECG recordings was comparable to that with 24 hours Holter (4.6%, 95% CI 3.5% to 5.7%). Intermittent recordings for 19 min total produced similar AF detection to 24 hours Holter monitoring.
Portable ECG devices may offer an efficient screening option for AF compared with 24 hours Holter monitoring.
CRD42017061021.
最近的技术进步使得使用单导联心电图监测设备进行心律监测成为可能，这可用于心房颤动（房颤）的早期诊断。我们旨在研究使用便携式心电图设备与动态心电图监测相比对房颤的检测率。
设置、参与者和结果测量：我们使用与房颤筛查相关的搜索词在 Medline、Embase 和 Scopus 数据库中进行搜索（于 2017 年 5 月 8 日进行），并纳入了使用便携式心电图设备或动态心电图监测进行房颤检测的成年患者（年龄＞18 岁）的研究。我们排除了使用植入式环路记录器和起搏器的研究。使用随机效应模型计算了总体房颤检测率。进行了荟萃回归分析以探索异质性的潜在来源。使用 Downs 和 Black 开发的工具评估报告质量。
便携式心电图监测在 18 项研究（n=117436）中使用，动态心电图监测在 36 项研究（n=8498）中使用。使用便携式心电图监测的房颤检测率为 1.7%（95%CI 1.4 至 2.1），各研究之间存在显著的异质性（p＜0.001）。总监测时间与房颤检测率之间存在中度线性关系（r=0.65，p=0.003），荟萃回归确定总监测时间（p=0.005）和体重指数（p=0.01）为异质性的潜在来源。在 8 项研究（n=10199）中进行多次心电图记录的检测率（4.8%，95%CI 3.6%至 6.0%）与 24 小时动态心电图监测相似（4.6%，95%CI 3.5%至 5.7%）。总共 19 分钟的间歇性记录与 24 小时动态心电图监测产生的房颤检测率相似。
与 24 小时动态心电图监测相比，便携式心电图设备可能是房颤的有效筛查选择。
PROSPERO 注册号：CRD42017061021。
