Younis Arwa, Nehoray Nofrat, Glikson Michael, Bodurian Christopher, Nof Eyal, Bragazzi Nicola Luigi, Berger Michael, Zareba Wojciech, Goldenberg Ilan, Beinart Roy
Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States.
Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel Aviv University, Ramat Gan, Israel.
Front Cardiovasc Med. 2022 Jun 3;9:881446. doi: 10.3389/fcvm.2022.881446. eCollection 2022.
Cardioversion (CV) for atrial fibrillation (AF) is common. We aimed to assess changes in QTc over time following electrical CV (ECV) for persistent AF, and to compare the benefit of using continuous Holter monitoring vs. conventional follow-up by ECG.
Prospective observational cohort study. We comprised 90 patients admitted to our center for elective ECV due to persistent AF who were prospectively enrolled from July 2017 to August 2018. All patients underwent 7-days Holter started prior to ECV. Baseline QTc was defined as median QTc during 1 h post ECV. The primary endpoint was QTc prolongation defined as QTc ≥500 ms, or ≥10% increase (if baseline QTc was >480 ms). Conventional monitoring was defined as 2-h ECG post ECV.
Mean age was 67 ± 11 years and 61% were male. Median baseline QTc was 452 ms (IQ range: 431-479 ms) as compared with a maximal median QTc of 474 ms (IQ range: 433-527 ms; <0.001 for the change in QTc from baseline). Peak median QTc occurred 44 h post ECV. The primary endpoint was met in 3 patients (3%) using conventional monitoring, compared with 39 new patients (43%) using Holter ( <0.001 for comparison). The Holter monitoring was superior to conventional monitoring in detecting clinically significant QTc prolongation (OR = 13; <0.001).
ECV of patients with persistent AF was associated with increased transient risk of QTc prolongation in nearly half of the patients. Peak median QTc occurs during end of second day following ECV and prolonged ECG monitoring provides superior detection of significant QTc prolongation compared with conventional monitoring.
心房颤动（AF）的心脏复律（CV）很常见。我们旨在评估持续性AF患者接受电复律（ECV）后QTc随时间的变化，并比较使用连续动态心电图监测与传统心电图随访的益处。
前瞻性观察队列研究。我们纳入了2017年7月至2018年8月期间因持续性AF入住我们中心接受择期ECV的90例患者。所有患者在ECV前开始进行7天的动态心电图监测。基线QTc定义为ECV后1小时内的QTc中位数。主要终点是QTc延长，定义为QTc≥500毫秒，或增加≥10%（如果基线QTc>480毫秒）。传统监测定义为ECV后2小时心电图。
平均年龄为67±11岁，61%为男性。基线QTc中位数为452毫秒（四分位间距：431 - 479毫秒），而最大QTc中位数为474毫秒（四分位间距：433 - 527毫秒；QTc相对于基线的变化<0.001）。QTc中位数峰值出现在ECV后44小时。使用传统监测时，3例患者（3%）达到主要终点，而使用动态心电图监测时有39例新患者（43%）达到主要终点（比较<0.001）。在检测具有临床意义的QTc延长方面，动态心电图监测优于传统监测（比值比 = 13；<0.001）。
持续性AF患者的ECV与近一半患者QTc延长的短暂风险增加有关。QTc中位数峰值出现在ECV后第二天结束时，与传统监测相比，延长的心电图监测能更好地检测出显著的QTc延长。
