Klingenheben Thomas, Albakri Aref, M Helms Thomas
Praxis für Kardiologie, und Ambulante Herzkatheterkooperation, Bonn, Germany.
Deutsche Stiftung für chronisch Kranke, Fürth, Germany.
J Atr Fibrillation. 2019 Apr 30;11(6):2161. doi: 10.4022/jafib.2161. eCollection 2019 Apr.
Initiation of antiarrhythmic drug therapy (AADx) for atrial fibrillation (AF) on an outpatient basis requires intensive ECG monitoring in order to assess antiarrhythmic efficacy as well as ECG signals of potential proarrhythmia. Dronedarone (DRO) reduces cardiovascular endpoints in AF patients fulfilling criteria of the ATHENA trial [1]. In the present study transtelephonic ECG monitoring was used to guide initiation of AADx in AF patients fulfilling the ATHENA criteria. In 19 consecutive patients (37% female; age 65+10 years; LVEF 62+7%; mean CHA2DS2-VASc score 2.9 + 1.6 (median=2), with symptomatic non-permanent AF and additional cardiovascular risk factors, DRO was prescribed as AADx of first choice. Initiation of therapy and follow-up were monitored by transtelephonic ECG recordings (VITAPHONE™100 IR; Vitaphone GmbH; Germany). In patients with persistent AF, electrical cardioversion was performed on an outpatient basis when DRO was started. Patients were followed for changes in QT intervals as well as AF recurrency. ECGs were transmitted according to a scheduled FU form as well as any time in case of pts symptoms. Patients in whom DRO did not prevent AF recurrence were switched to alternative AADx, or to pulmonary vein isolation (PVI), respectively. At the end of long-term follow-up, DRO alone was successful in preventing AF recurrence in 5 of 19 patients (26%). When pts who responded to AADx of second or third choice or who underwent PVI were included, SR could be maintained in 17/19 pts (89%). No patient required discontinuation of AADx due to ventricular depolarization abnormalities, symptomatic bradycardia or pathologic QT prolongation. In conclusion, transtelephonic ECG transmission is useful for close rhythm monitoring during initiation and follow-up of AADx, also during change from DRO to other AADx. DRO was effective to prevent AF recurrence in 26% of patients during a mean long-term follow-up of more than 30 months - which is well in line with data from the literature.
门诊启动房颤（AF）抗心律失常药物治疗（AADx）需要进行密集的心电图监测，以评估抗心律失常疗效以及潜在致心律失常的心电图信号。决奈达隆（DRO）可降低符合ATHENA试验标准的房颤患者的心血管终点事件[1]。在本研究中，采用电话传输心电图监测来指导符合ATHENA标准的房颤患者启动AADx。连续纳入19例患者（女性占37%；年龄65±10岁；左心室射血分数62±7%；平均CHA2DS2-VASc评分为2.9±1.6（中位数=2）），有症状性非持续性房颤且伴有其他心血管危险因素，首选DRO作为AADx。通过电话传输心电图记录（VITAPHONE™100 IR；Vitaphone GmbH；德国）监测治疗启动及随访情况。对于持续性房颤患者，开始使用DRO时在门诊进行电复律。随访患者的QT间期变化以及房颤复发情况。心电图根据预定的随访表格进行传输，患者出现症状时也随时传输。DRO未能预防房颤复发的患者分别换用其他AADx或接受肺静脉隔离（PVI）。在长期随访结束时，仅DRO成功预防了19例患者中5例（26%）的房颤复发。当纳入对第二或第三选择的AADx有反应或接受PVI的患者时，19例患者中有17例（89%）可维持窦性心律（SR）。没有患者因心室去极化异常、症状性心动过缓或病理性QT延长而需要停用AADx。总之，电话传输心电图对于AADx启动及随访期间的密切心律监测很有用，在从DRO换用其他AADx时也是如此。在平均超过30个月的长期随访中，DRO在26%的患者中有效预防了房颤复发——这与文献数据相符。
