Jawad-Ul-Qamar Muhammad, Chua Winnie, Purmah Yanish, Nawaz Mohammad, Varma Chetan, Davis Russell, Maher Abdul, Fabritz Larissa, Kirchhof Paulus
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK.
Open Heart. 2020 May;7(1). doi: 10.1136/openhrt-2019-001151.
Prolonged ECG monitoring is clinically useful to detect unknown atrial fibrillation (AF) in stroke survivors. The diagnostic yield of prolonged ECG monitoring in other patient populations is less well characterised. We therefore studied the diagnostic yield of prolonged Holter ECG monitoring for AF in an patient cohort referred from primary care or seen in a teaching hospital.
We analysed consecutive 7-day ECG recordings in unselected patients referred from different medical specialities and assessed AF detection rates by indication, age and comorbidities.
Seven-day Holter ECGs (median monitoring 127.5 hours, IQR 116 to 152) were recorded in 476 patients (mean age 54.6 (SD 17.0) years, 55.9% female) without previously known AF, requested to evaluate palpitations (n=241), syncope (n=99), stroke or transient ischaemic attack (n=75), dizziness (n=29) or episodic chest pain (n=32). AF was newly detected in 42/476 (8.8%) patients. Oral anticoagulation was initiated in 40/42 (95.2%) patients with newly detected AF. Multivariate logistic regression, adjusted for age, sex and monitoring duration found four clinical parameters to be associated with newly detected AF: hypertension OR=2.54, (1.08 to 8.61) (adjusted OR (95% CI)), p=0.034; previous stroke or TIA OR=4.14 (1.81 to 13.01), p=0.001; left-sided valvular heart disease OR=5.07 (2.48 to 18.70), p<0.001 and palpitations OR=2.86, (1.33 to 10.44), p=0.015.
Open multispeciality access to prolonged ECG monitoring, for example, as part of integrated, cross-sector AF care, can accelerate diagnosis of AF and increase adequate use of oral anticoagulation, especially in older and symptomatic patients with comorbidities.
延长心电图监测对于检测卒中幸存者中未知的心房颤动（AF）具有临床实用价值。在其他患者群体中，延长心电图监测的诊断率特征尚不明确。因此，我们研究了在由初级保健机构转诊或在教学医院就诊的患者队列中，延长动态心电图监测对AF的诊断率。
我们分析了来自不同医学专科的未入选患者连续7天的心电图记录，并按指征、年龄和合并症评估AF检出率。
476例既往无已知AF的患者进行了为期7天的动态心电图监测（中位监测时间127.5小时，四分位间距116至152小时），这些患者因心悸（n = 241）、晕厥（n = 99）、卒中或短暂性脑缺血发作（n = 75）、头晕（n = 29）或发作性胸痛（n = 32）而被要求进行评估。42/476（8.8%）例患者新检测到AF。40/42（95.2%）例新检测到AF的患者开始口服抗凝治疗。在对年龄、性别和监测持续时间进行校正的多因素逻辑回归分析中，发现有四个临床参数与新检测到的AF相关：高血压，比值比（OR）=2.54，（1.08至8.61）（校正OR（95%置信区间）），p = 0.034；既往卒中或短暂性脑缺血发作，OR = 4.14（1.81至13.01），p = 0.001；左侧瓣膜性心脏病，OR = 5.07（2.48至18.70），p<0.001；心悸，OR = 2.86，（1.33至10.44），p = 0.015。
开放多专科的延长心电图监测途径，例如作为综合、跨部门AF护理的一部分，可以加速AF的诊断并增加口服抗凝药物的合理使用，尤其是在有合并症的老年和有症状患者中。
