Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
J Intensive Care Med. 2023 Sep;38(9):809-815. doi: 10.1177/08850666231164613. Epub 2023 Mar 20.
Following cardiac surgery, 50% to 60% of patients with congenital heart disease will experience an arrhythmia. These arrhythmias are associated with increased morbidity and mortality. Therefore, rapid and accurate identification is paramount to the improvement of patient outcome. We hypothesize that the AtriAmp, a device which allows atrial electrogram (AEG) display on the bedside monitors, will increase provider accuracy and confidence in arrhythmia diagnosis. A prospective observational study. Electrograms were collected from post-operative patients from the bedside monitors surface ECG and an AEG using the AtriAmp. A 12-question online survey was given to critical care and cardiology providers at 9 different programs across the country as well as being posted to the AAP SOCC fall newsletter. Six questions displayed signals from only the surface leads, while the other 6 showed the same arrhythmias with an AEG obtained from the AtriAmp. Answers were then evaluated for confidence and accuracy. A paired -test along with mixed method modeling was used to assess the data. Cardiac pediatric ICU. Providers in pediatric cardiology and pediatric critical care were evaluated on their ability to diagnose arrhythmias on surface ECG and AEG obtained from bedside monitor. The accuracy and confidence of diagnosis of both surface and AEG signals were evaluated through an on-line survey. Eighty-eight providers completed the survey. The study showed that interpreting with the AtriAmp signal, compared to the surface ECG only, significantly increased the accuracy ( = .002) and confidence in provider rhythm diagnosis ( < .001). Junctional ectopic tachycardia, sinus tachycardia, and complete heart block had the most significant increase in accuracy of diagnose when using the AtriAmp signal ( < .001, = .002, = .010, respectively). Use of the AtriAmp increased provider accuracy and confidence in post-operative rhythm diagnosis when compared to diagnosis using the surface electrograms only.
先天性心脏病患者心脏手术后，50%到 60%会出现心律失常。这些心律失常与发病率和死亡率增加有关。因此，快速准确的识别对于改善患者预后至关重要。我们假设 AtriAmp 设备可在床边监护仪上显示心房电图（AEG），这将提高医务人员对心律失常诊断的准确性和信心。一项前瞻性观察研究。从床边监护仪表面心电图和 AtriAmp 采集术后患者的心电记录。在全国 9 个不同的项目中，向儿科重症监护和心脏病学医务人员以及 AAP SOCC 秋季通讯发送了一份包含 12 个问题的在线调查。前 6 个问题只显示来自表面导联的信号，而另外 6 个问题显示来自 AtriAmp 的相同心律失常信号。然后根据信心和准确性对答案进行评估。采用配对检验和混合方法模型来评估数据。儿科心脏重症监护室。评估儿科心脏病学和儿科重症监护医务人员在表面心电图和床边监护仪获得的 AEG 上诊断心律失常的能力。通过在线调查评估表面和 AEG 信号的诊断准确性和信心。88 名医务人员完成了调查。研究表明，与仅使用表面心电图相比，使用 AtriAmp 信号进行解读可显著提高诊断准确性（ = .002）和医务人员对节律诊断的信心（ < .001）。使用 AtriAmp 信号时，诊断交接性心动过速、窦性心动过速和完全性心脏阻滞的准确性有显著提高（ < .001、 = .002、 = .010，分别）。与仅使用表面心电图相比，使用 AtriAmp 可提高医务人员对术后节律诊断的准确性和信心。
