在不列颠哥伦比亚省维多利亚市，于看心脏病专家之前的等待期内对有症状心律失常进行早期诊断——捕捉房颤
Catch-AF-Early Diagnosis of Symptomatic Arrythmias in the Waiting Period Prior to Seeing a Cardiologist in Victoria, British Columbia.
作者信息
Coxon Matthew W, Hoskin Kurt, van Zyl Martin, Thibert Michael, Sikkel Markus
机构信息
Victoria Cardiac Arrhythmia Trials Inc., Victoria, British Columbia, Canada.
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
CJC Open. 2024 Sep 25;6(12):1476-1483. doi: 10.1016/j.cjco.2024.09.007. eCollection 2024 Dec.
BACKGROUND
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Given its often-paroxysmal nature, screening at a single time point, using a 12-lead electrocardiogram (ECG) or a Holter monitor, has limited benefit. The AliveCor KardiaMobile device is a validated ECG recorder that can be used for patient-directed arrhythmia diagnosis and symptom-rhythm correlation. The aim of this study was to evaluate whether using the KardiaMobile device could reduce the time-to-diagnosis, for AF as well as other arrhythmias. We hypothesized that providing patients with a KardiaMobile device during their waiting period for specialist care could reduce the length of time that passes before ECG detection of arrhythmia.
METHODS
Patients were randomized 1:1 to receive either standard monitoring (ECG and a Holter monitor) or enhanced monitoring (ECG, a Holter monitor, and a KardiaMobile device). Patients were instructed to upload ECG recordings if they had cardiac symptoms, so that symptom-rhythm correlation could be achieved. The primary outcome was the time-to-diagnosis for AF. The secondary endpoint was the time-to-diagnosis for any arrhythmias.
RESULTS
From October 2018 to October 2022, a total of 69 patients were enrolled, and they were followed up to 12 months. Overall, 6 of the 7 patients diagnosed with AF were in the enhanced-monitoring group ( = 0.106). The time-to-diagnosis was not significantly different in the 2 groups ( = 0.053). Overall arrhythmias were diagnosed in 10 patients (29%) in the standard-monitoring arm, compared to 22 patients (63%) in the enhanced-monitoring arm ( = 0.008). The time-to-diagnosis was reduced in the enhanced-monitoring arm ( = 0.010).
CONCLUSIONS
The time-to-diagnosis of any arrhythmia was reduced significantly in patients randomized to receive KardiaMobile device monitoring. Providing patients with a KardiaMobile device may expedite the diagnosis of arrhythmias during the waiting period for specialist care.
CLINICAL TRIAL REGISTRATION
NCT04302311.
背景
心房颤动（AF）是最常见的心律失常。鉴于其通常为阵发性的特点，使用12导联心电图（ECG）或动态心电图监测仪在单一时间点进行筛查，益处有限。AliveCor KardiaMobile设备是一种经过验证的心电图记录仪，可用于患者自主的心律失常诊断及症状与心律的相关性分析。本研究的目的是评估使用KardiaMobile设备是否能缩短房颤及其他心律失常的诊断时间。我们假设在患者等待专科治疗期间为其提供KardiaMobile设备，可以缩短心电图检测到心律失常之前所经过的时间。
方法
患者按1:1随机分组，分别接受标准监测（心电图和动态心电图监测仪）或强化监测（心电图、动态心电图监测仪和KardiaMobile设备）。如果患者出现心脏症状，会被指导上传心电图记录，以便实现症状与心律的相关性分析。主要结局是房颤的诊断时间。次要终点是任何心律失常的诊断时间。
结果
2018年10月至2022年10月，共纳入69例患者，并对他们进行了长达12个月的随访。总体而言，7例被诊断为房颤的患者中有6例在强化监测组（P = 0.106）。两组的诊断时间无显著差异（P = 0.053）。标准监测组有10例患者（29%）被诊断为总体心律失常，而强化监测组有22例患者（63%）被诊断为总体心律失常（P = 0.008）。强化监测组的诊断时间缩短（P = 0.010）。
结论
随机接受KardiaMobile设备监测的患者，任何心律失常的诊断时间显著缩短。在患者等待专科治疗期间为其提供KardiaMobile设备，可能会加快心律失常的诊断。
临床试验注册
NCT04302311。
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