Gupta Nigel, Yang Jingrong, Reynolds Kristi, Lenane Judith, Garcia Elisha, Sung Sue Hee, Harrison Teresa N, Solomon Matthew D, Go Alan S
Department of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Am J Cardiol. 2022 Mar 1;166:38-44. doi: 10.1016/j.amjcard.2021.11.027. Epub 2021 Dec 23.
Accurate diagnosis of arrhythmias is improved with longer monitoring duration but can risk delayed diagnosis. We compared diagnostic yield, outcomes, and resource utilization by arrhythmia monitoring strategy in 330 matched adults (mean age 64 years, 40% women, and 30% non-White) without previously documented atrial fibrillation or atrial flutter (AF/AFL) who received ambulatory electrocardiographic monitoring by 14-day Zio XT (patch-based continuous monitor), 24-hour Holter, or 30-day event monitor (external loop recorder) between October 2011 and May 2014. Patients were matched by age, gender, site, likelihood of receiving Zio XT patch, and indication for monitoring, and subsequently followed for monitoring results, management changes, clinical outcomes, and resource utilization. AF/AFL ≥30 seconds was noted in 6% receiving Zio XT versus 0% by Holter (p = 0.04) and 3% by event monitor (p = 0.07). Nonsustained ventricular tachycardia was noted in 24% for Zio XT patch versus 8% (p <0.001) for Holter and 4% (p <0.001) for event monitor. No significant differences between monitoring strategies in outcomes or resource utilization were observed. Prolonged monitoring with 14-day Zio XT patch or 30-day event monitor was superior to 24-hour Holter in detecting new AF/AFL but not different from each other. Documented nonsustained ventricular tachycardia was more frequent with Zio XT than 24-hour Holter and 30-day event monitor without apparent increased risk of adverse outcomes or excess utilization. In conclusion, additional efforts are needed to further personalize electrocardiographic monitoring strategies that optimize clinical management and outcomes.
延长监测时间可提高心律失常的准确诊断率，但可能存在诊断延迟的风险。我们比较了330名匹配的成年人（平均年龄64岁，40%为女性，30%为非白人）采用心律失常监测策略的诊断率、结果和资源利用情况，这些成年人之前未记录到心房颤动或心房扑动（AF/AFL），在2011年10月至2014年5月期间接受了14天的Zio XT（基于贴片的连续监测器）、24小时动态心电图或30天事件监测器（外部环路记录器）的动态心电图监测。患者按年龄、性别、地点、接受Zio XT贴片的可能性和监测指征进行匹配，随后跟踪监测结果、管理变化、临床结果和资源利用情况。接受Zio XT监测的患者中6%记录到AF/AFL≥30秒，而接受动态心电图监测的患者中这一比例为0%（p = 0.04），接受事件监测器监测的患者中这一比例为3%（p = 0.07）。Zio XT贴片监测到非持续性室性心动过速的比例为24%，而动态心电图监测为8%（p <0.001），事件监测器监测为4%（p <0.001）。在结果或资源利用方面，各监测策略之间未观察到显著差异。采用14天的Zio XT贴片或30天的事件监测器进行延长监测在检测新发AF/AFL方面优于24小时动态心电图，但两者之间无差异。记录到的非持续性室性心动过速在Zio XT监测中比24小时动态心电图和30天事件监测器更常见，且未明显增加不良结局风险或过度利用资源。总之，需要进一步努力使心电图监测策略更加个性化，以优化临床管理和结果。
