Koole Maarten A, Kauw Dirkjan, Kooiman Kirsten M, de Groot Joris R, Robbers-Visser Danielle, Tulevski Igor I, Mulder Barbara J, Bouma Berto J, Schuuring Mark J
Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Cardiology Centers of the Netherlands, Amsterdam, Netherlands.
Front Cardiovasc Med. 2023 Jan 6;9:1099014. doi: 10.3389/fcvm.2022.1099014. eCollection 2022.
The European Society of Cardiology (ESC) guidelines for the management of adult congenital heart disease (ACHD) recommend screening in patients at risk for arrhythmic events. However, the optimal mode of detection is unknown.
Baseline and follow-up data of symptomatic ACHD patients who received an implantable loop recorder (ILR) or who participated in a smartphone based single-lead electrocardiogram study were collected. The primary endpoint was time to first detected arrhythmia.
In total 116 ACHD patients (mean age 42 years, 44% male) were studied. The ILR group ( = 23) differed from the smartphone based single-lead electrocardiogram group ( = 93) in having a greater part of males and had more severe CHD and (near) syncope as qualifying diagnosis. In the smartphone based single-lead electrocardiogram group history of arrhythmia and palpitations were more frequent (all < 0.05). Monitoring was performed for 40 and 79 patient-years for the ILR- and smartphone based single-lead electrocardiogram group, respectively. Arrhythmias occurred in 33 patients with an equal median time for both groups to first arrhythmia of 3 months (HR of 0.7, = 0.81). Furthermore, atrial fibrillation occurred most often ( = 16) and common therapy changes included medication changes ( = 7) and implantation of pacemaker or Implantable Cardioverter Defibrillator (ICD) ( = 4). Symptoms or mode of detection were not a determinant of the first event.
Non-invasive smartphone based single-lead electrocardiogram monitoring could be an acceptable alternative for ILR implantation in detecting arrhythmia in symptomatic ACHD patients in respect to diagnostic yield, safety and management decisions, especially in those without syncope.
欧洲心脏病学会（ESC）成人先天性心脏病（ACHD）管理指南建议对有发生心律失常事件风险的患者进行筛查。然而，最佳检测方式尚不清楚。
收集了接受植入式循环记录仪（ILR）或参与基于智能手机的单导联心电图研究的有症状ACHD患者的基线和随访数据。主要终点是首次检测到心律失常的时间。
共研究了116例ACHD患者（平均年龄42岁，44%为男性）。ILR组（n = 23）与基于智能手机的单导联心电图组（n = 93）不同，男性比例更高，患有更严重的冠心病，且（近乎）晕厥作为合格诊断的情况更多。在基于智能手机的单导联心电图组中，心律失常和心悸病史更常见（所有P < 0.05）。ILR组和基于智能手机的单导联心电图组的监测时间分别为40和79患者年。33例患者发生了心律失常，两组首次心律失常的中位时间相等，均为3个月（HR为0.7，P = 0.81）。此外，房颤最常发生（n = 16），常见的治疗变化包括药物改变（n = 7）和植入起搏器或植入式心脏复律除颤器（ICD）（n = 4）。症状或检测方式不是首次事件的决定因素。
就诊断率、安全性和管理决策而言，尤其是对于那些没有晕厥的患者，基于智能手机的无创单导联心电图监测可能是ILR植入在检测有症状ACHD患者心律失常方面可接受的替代方法。
