Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria.
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
Clin Cardiol. 2024 Dec;47(12):e24331. doi: 10.1002/clc.24331.
A recent European Heart Rhythm Association (EHRA) practical guide provides guidance on the use of novel digital devices for heart rhythm analysis using either electrocardiogram (ECG) or photoplethysmography (PPG) technology for the diagnosis of atrial fibrillation (AF). This survey assesses physicians' preferences to use digital devices in patients with possible AF and their impact on clinical decision-making.
Participants of the DAS-CAM III initiated and distributed an online survey assessing physician preferences in using digital devices for the management of AF in different clinical scenarios. A total of 505 physicians (median age: 38 [IQR 33-46] years) from 30 countries completed the survey. A third of respondents were electrophysiologists, the others were cardiologists, cardiology residents, or general practitioners. Electrophysiologists were more likely to have experience with both ECG-based (92% vs. 68%, p < 0.001) and PPG-based (60% vs. 34%, p < 0.001) digital devices. The initial diagnostic approach to each scenario (symptomatic low-risk, symptomatic high-risk, or asymptomatic high-risk patient) was heterogeneous. Electrophysiologists preferred intermittent single-lead ECG monitoring to traditional Holter ECGs to screen for AF. Both electrophysiologists and non-electrophysiologists would rarely use PPG-based devices to diagnose and screen for AF (8.2%-9.8%). Electrophysiologists and non-electrophysiologists use ECG-based technology to confirm PPG-documented tracings suggestive of AF.
While PPG-based digital devices are rarely used for diagnosis and screening for AF, intermittent ECG-based digital devices are beginning to be implemented in clinical practice. More education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide.
最近，欧洲心律协会（EHRA）发布了一份实用指南，就使用心电图（ECG）或光电容积描记法（PPG）技术的新型数字设备进行心律失常分析，以诊断心房颤动（AF），提供了使用指导。本调查评估了医生在可能患有 AF 的患者中使用数字设备的偏好及其对临床决策的影响。
DAS-CAM III 研究的参与者启动并分发了一项在线调查，评估医生在不同临床情况下使用数字设备管理 AF 的偏好。来自 30 个国家的 505 名医生（中位数年龄：38 [IQR 33-46] 岁）完成了这项调查。三分之一的受访者为电生理学家，其余的为心脏病专家、心脏病学住院医师或全科医生。电生理学家更有可能具有基于 ECG（92%比 68%，p<0.001）和基于 PPG（60%比 34%，p<0.001）的数字设备的经验。对每种情况（症状性低危、症状性高危或无症状高危患者）的初始诊断方法是不同的。电生理学家更倾向于使用间歇性单导联 ECG 监测来筛查 AF，而不是传统的 Holter ECG。电生理学家和非电生理学家很少会使用基于 PPG 的设备来诊断和筛查 AF（8.2%-9.8%）。电生理学家和非电生理学家使用基于 ECG 的技术来确认 PPG 记录的提示 AF 的迹线。
虽然基于 PPG 的数字设备很少用于 AF 的诊断和筛查，但间歇性基于 ECG 的数字设备已开始在临床实践中实施。需要进行更多关于新型数字设备潜力的教育，以实现 EHRA 实用指南所建议的诊断途径。
