Laubham Matthew, Dodeja Anudeep K, Kumthekar Rohan, Shay Victoria, D'Emilio Nathan, Conroy Sara, Mah May Ling, Alvarado Chance, Kamp Anna
Nationwide Children's Hospital Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
The Ohio State University Medical Center, Columbus, OH, 43210, USA.
Pediatr Cardiol. 2024 Aug 16. doi: 10.1007/s00246-024-03614-6.
The aim of this study was to evaluate the accuracy of the KardiaMobile (KM) device in adults with a Fontan palliation, and to assess the KM function as a screening tool for atrial arrhythmias. While patient driven electrocardiogram (EKG) devices are becoming a validated way to evaluate cardiac arrhythmias, their role for patients with congenital heart disease is less clear. Patients with single ventricle Fontan palliation have a high prevalence of atrial arrhythmias and represent a unique cohort that could benefit from early detection of atrial arrhythmias. This single center prospective study enrolled adult patients with Fontan palliation to use the KM heart rhythm monitoring device for both symptomatic episodes and asymptomatic weekly screening over a 1-year period. Accuracy was assessed by comparing the automatic KM interpretation (KM-auto) to an electrophysiologist overread (KM-EP) and traditional EKG. Fifty patients were enrolled and 510 follow-up transmissions were received. The sensitivity and specificity of enrollment KM-auto compared to EKG was 65% and 100%, respectively. The sensitivity and specificity of enrollment KM-auto compared to the KM-EP was 75% and 96%, respectively. In the adult Fontan palliation, the accuracy of the KM device to detect a normal rhythm was reliable and best with a physician overread. Abnormal or uninterpretable KM-auto device interpretations, symptomatic transmissions, and any transmissions with a high heart rate compared to a patient's normal baseline should warrant further review.
本研究的目的是评估 KardiaMobile（KM）设备在接受Fontan姑息手术的成人患者中的准确性，并评估KM作为房性心律失常筛查工具的功能。虽然患者驱动的心电图（EKG）设备正成为评估心律失常的一种有效方法，但其在先天性心脏病患者中的作用尚不清楚。单心室Fontan姑息手术患者房性心律失常的患病率很高，是一个独特的群体，可能从房性心律失常的早期检测中受益。这项单中心前瞻性研究纳入了接受Fontan姑息手术的成年患者，让他们在1年的时间里使用KM心律监测设备对有症状发作和无症状的每周筛查进行监测。通过将KM自动解读（KM-auto）与电生理学家的复核解读（KM-EP）以及传统EKG进行比较来评估准确性。共纳入50名患者，收到510次随访传输数据。与EKG相比，入组时KM-auto的敏感性和特异性分别为65%和100%。与KM-EP相比，入组时KM-auto的敏感性和特异性分别为75%和96%。在接受Fontan姑息手术的成人患者中，KM设备检测正常心律的准确性可靠，经医生复核解读时最佳。与患者正常基线相比，KM-auto设备的异常或无法解读的解读、有症状的传输以及任何心率较高的传输都应进行进一步复查。
