Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,
Cardiology. 2021;146(2):207-212. doi: 10.1159/000512656. Epub 2021 Jan 21.
The aim of the present study was to compare the rate of actionable arrhythmic events between patients with hypertrophic cardiomyopathy (HCM) who are monitored with an insertable cardiac monitor (ICM) or Holter monitoring.
We studied 50 patients (mean age 52 years, 72% men) with HCM at low or intermediate risk for sudden cardiac death (SCD), of whom 25 patients received an ICM between November 2014 and February 2019. We retrospectively identified a control group of 25 patients who were matched on age, sex, and HCM Risk-SCD score category. The mean HCM Risk-SCD score was 3.41 ± 1.31 and 3.31 ± 1.43 for the ICM and Holter groups, respectively. The primary endpoint was an actionable event which was defined as an arrhythmic event resulting in a change in patient management. The secondary endpoint was the occurrence of ventricular tachycardia (VT).
The cumulative actionable event rate at 30 months was higher in the ICM group (51 vs. 27%, log-rank p value <0.01). De novo atrial fibrillation requiring oral anticoagulation occurred only in the ICM group (n = 3). Overall, 4 implantable cardioverter-defibrillators were implanted for primary prevention (n = 2 in each group). The cumulative rate of VT episodes at 30 months was similar between groups (23% [ICM group] vs. 42% [Holter group], log-rank p value = 0.71). Furthermore, the characteristics of VT were similar between groups with regard to the number of beats and rate.
In adults with HCM, an ICM will detect more arrhythmic events requiring an intervention than a conventional Holter strategy. In contrast, the diagnostic yield of detecting VT seems similar for both groups.
本研究旨在比较植入式心脏监测仪（ICM）与动态心电图监测（Holter 监测）在监测肥厚型心肌病（HCM）患者心律失常事件发生率方面的差异。
我们研究了 50 名低危或中危发生心源性猝死（SCD）风险的 HCM 患者（平均年龄 52 岁，72%为男性），其中 25 名患者于 2014 年 11 月至 2019 年 2 月期间接受了 ICM 监测。我们回顾性地确定了 25 名年龄、性别和 HCM 风险-SCD 评分匹配的对照组患者。ICM 组和 Holter 组的平均 HCM 风险-SCD 评分为 3.41 ± 1.31 和 3.31 ± 1.43。主要终点为可采取行动的事件，定义为导致患者管理方式改变的心律失常事件。次要终点为室性心动过速（VT）的发生。
30 个月时，ICM 组的累积可采取行动事件发生率更高（51%比 27%，对数秩检验 p 值<0.01）。仅在 ICM 组中发生了需要口服抗凝治疗的新发心房颤动（n = 3）。总的来说，植入了 4 台植入式心脏复律除颤器用于一级预防（每组 2 台）。30 个月时，两组的 VT 发作累积发生率相似（ICM 组 23%，Holter 组 42%，对数秩检验 p 值=0.71）。此外，两组 VT 的特征在发作次数和心率方面相似。
在 HCM 成人患者中，与常规 Holter 策略相比，ICM 可检测到更多需要干预的心律失常事件。相比之下，两组检测 VT 的诊断效果似乎相似。
