Department of Neurology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, The Netherlands.
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Europace. 2023 Feb 8;25(1):156-163. doi: 10.1093/europace/euac104.
To evaluate the clinical effectiveness of routine 24 h Holter monitoring to screen for conduction disturbances and arrhythmias in patients with myotonic dystrophy type 1 (DM1).
A retrospective two-centre study was conducted including DM1-affected individuals undergoing routine cardiac screening with at least one 24 h Holter monitoring between January 2010 and December 2020. For each individual, the following data were collected: Holter results, results of electrocardiograms (ECGs) performed at the same year as Holter monitoring, presence of cardiac complaints, and neuromuscular status. Holter findings were compared with the results of cardiac screening (ECG + history taking) performed at the same year. Cardiac conduction abnormalities and/or arrhythmias that would have remained undiagnosed based on history taking and ECG alone were considered de novo findings. A total 235 genetically confirmed DM1 patients were included. Abnormal Holter results were discovered in 126 (54%) patients after a mean follow-up of 64 ± 28 months in which an average of 3 ± 1 Holter recordings per patient was performed. Abnormalities upon Holter mainly consisted of conduction disorders (70%) such as atrioventricular (AV) block. Out of 126 patients with abnormal Holter findings, 74 (59%) patients had de novo Holter findings including second-degree AV block, atrial fibrillation/flutter and non-sustained ventricular tachycardia. Patient characteristics were unable to predict the occurrence of de novo Holter findings. In 39 out of 133 (29%) patients with normal ECGs upon yearly cardiac screening, abnormalities were found on Holter monitoring during follow-up.
Twenty-four hour Holter monitoring is of added value to routine cardiac screening for all DM1 patients.
评估常规 24 小时动态心电图监测在 1 型肌强直性营养不良（DM1）患者中筛查传导障碍和心律失常的临床效果。
进行了一项回顾性的双中心研究，纳入了 2010 年 1 月至 2020 年 12 月期间接受常规心脏筛查且至少进行过一次 24 小时动态心电图监测的 DM1 患者。对于每位患者，收集了以下数据：动态心电图结果、同年进行的心电图（ECG）结果、是否存在心脏主诉以及神经肌肉状况。将动态心电图结果与同年进行的心脏筛查（ECG+病史采集）结果进行比较。如果仅凭病史采集和 ECG 无法诊断的心脏传导异常和/或心律失常，则视为新发现。共纳入 235 例经基因证实的 DM1 患者。在平均 64±28 个月的随访中，126 例（54%）患者出现异常动态心电图结果，其中每位患者平均进行 3±1 次动态心电图记录。动态心电图异常主要表现为传导障碍（70%），如房室（AV）阻滞。在 126 例动态心电图异常患者中，74 例（59%）患者出现新的动态心电图异常，包括二度房室阻滞、心房颤动/扑动和非持续性室性心动过速。患者特征无法预测新的动态心电图异常的发生。在 133 例每年心脏筛查心电图正常的患者中，39 例在随访期间的动态心电图监测中发现异常。
24 小时动态心电图监测对所有 DM1 患者的常规心脏筛查具有附加价值。
