植入时 R 波振幅的变化与可植入心脏监测器的性别和插入方向有关：来自 confirm Rx™ 身体姿势和身体活动研究的观察结果。
Changes in R-wave amplitude at implantation are associated with gender and orientation of insertable cardiac monitor: observations from the confirm Rx™ body posture and physical activity study.
机构信息
The Valley Private Hospital, Mulgrave, VIC, Australia.
St. John of God Murdoch Hospital, Murdoch, WA, Australia.
出版信息
BMC Cardiovasc Disord. 2022 Oct 8;22(1):439. doi: 10.1186/s12872-022-02752-0.
BACKGROUND
Insertable cardiac monitors (ICMs) are small subcutaneously implanted devices that detect changes in R-wave amplitudes (RWAs), effective in arrhythmia-monitoring. Although ICMs have proven to be immensely successful, electrical artefacts are frequent and can lead to misdiagnosis. Thus, there is a growing need to sustain and increase efficacy in detection rates by gaining insight into various patient-specific factors such as body postures and activities.
METHODS
RWAs were measured in 15 separate postures, including supine, lying on the right-side (RS) or left-side (LS) and sitting, and two separate ICM orientations, immediately after implantation of Confirm Rx™ ICM in 99 patients.
RESULTS
The patients (53 females and 46 males, mean ages 66.62 ± 14.7 and 66.40 ± 12.25 years, respectively) had attenuated RWAs in RS, LS and sitting by ~ 26.4%, ~ 27.8% and ~ 21.2% respectively, compared to supine. Gender-based analysis indicated RWAs in RS (0.32 mV (0.09-1.03 mV), p < 0.0001) and LS (0.37 mV (0.11-1.03 mV), p = 0.004) to be significantly attenuated compared to supine (0.52 mV (0.20-1.03 mV) for female participants. Similar attenuation was not evident for male participants. Further, parasternally oriented ICMs (n = 44), attenuated RWAs in RS (0.37 mV(0.09-1.03 mV), p = 0.05) and LS (0.34 mV (0.11-1.03 mV), p = 0.02) compared to supine (0.48 mV (0.09-1.03 mV). Similar differences were not observed in participants with ICMs in the 45°-relative-to-sternum (n = 46) orientation. When assessing the combined effect of gender and ICM orientation, female participants demonstrated plausible attenuation in RWAs for RS and LS postures compared to supine, an effect not observed in male participants.
CONCLUSION
This is the first known study depicting the effects on RWA due to body postures and activities immediately post-implantation with an overt impact by gender and orientation of ICM. Future work assessing the cause of gender-based differences in RWAs may be critical.
TRIAL REGISTRATION
Clinical Trials, NCT03803969. Registered 15 January 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT03803969.
背景
可植入心脏监测器（ICM）是一种小型皮下植入设备，可检测 R 波幅度（RWA）的变化，对心律失常监测非常有效。尽管 ICM 已被证明非常成功，但电伪影很常见，可能导致误诊。因此，需要通过深入了解各种患者特定因素（如体位和活动）来维持和提高检测率。
方法
在 99 名患者植入 Confirm Rx™ICM 后，立即测量了 15 种不同体位（包括仰卧位、右侧卧位（RS）或左侧卧位（LS）和坐位）和两种不同的 ICM 方向的 RWA。
结果
与仰卧位相比，患者（53 名女性和 46 名男性，平均年龄分别为 66.62 ± 14.7 和 66.40 ± 12.25 岁）在 RS、LS 和坐位时的 RWA 分别减弱了约 26.4%、27.8%和 21.2%。基于性别的分析表明，与仰卧位相比，RS（0.32 mV（0.09-1.03 mV），p < 0.0001）和 LS（0.37 mV（0.11-1.03 mV），p = 0.004）的 RWA 明显减弱。与女性参与者相比，女性参与者的 RS（0.52 mV（0.20-1.03 mV））和 LS（0.52 mV（0.20-1.03 mV））的 RWA 减弱更明显。然而，男性参与者则没有明显的衰减。此外，对于采用胸骨旁方向放置的 ICM（n = 44），与仰卧位相比，RS（0.37 mV（0.09-1.03 mV），p = 0.05）和 LS（0.34 mV（0.11-1.03 mV））的 RWA 减弱，p = 0.02）。在 ICM 角度为 45°相对胸骨的 46 名参与者中没有观察到类似的差异。当评估性别和 ICM 方向的综合影响时，与仰卧位相比，女性参与者的 RS 和 LS 体位的 RWA 可能明显减弱，但男性参与者则没有观察到这种减弱。
结论
这是第一份已知的研究，描述了植入后即刻因体位和活动而导致的 RWA 变化，并明显受到性别和 ICM 方向的影响。未来评估 RWA 中性别差异的原因可能至关重要。
试验注册
临床试验，NCT03803969。2019 年 1 月 15 日注册-回顾性注册，https://clinicaltrials.gov/NCT03803969。
Zotero 插件