远程监测系统对心脏起搏器患者中房颤的监测效果  

Atrial Fibrillation Detection in Du-al-Chamber Pacemaker Recipients by Using Remote Monitoring System

作　　者：张倩 王志蕾[2] 金鑫[2] 张雁飞 佟佳宾[2] 施海峰[2] 陈浩[2] 刘俊鹏[2] 杨杰孚[2] 邹彤[2] 

机构地区：[1]深圳大学总医院心内科,广东深圳 [2]北京医院心内科,北京 [3]国家老年医学中心北京医院,北京

出　　处：《临床医学进展》2019年第3期215-224,共10页Advances in Clinical Medicine

基　　金：《首都临床特色应用研究与成果推广》项目基金资助,课题编号:Z171100001017203.

摘　　要：目的:观察远程监测系统能否对房颤患者进行早期诊断予及时治疗。方法:这是一项单中心对照研究,连续选取北京医院2009~04至2015~04期间植入Biotronic双腔起搏器的老年患者316例,按照起搏器是否具有远程功能分成远程监测组(实验组)和常规诊室随访组(对照组),平均随访24.4 ±1.8个月,比较两组房颤发作的诊断时间、持续时间、房颤负荷及抗凝比例。结果:随访中69例患者出现房颤发作(实验组38例,对照组31例),总发病率23.4%,89.9%的患者(实验组36例,对照组26例,P = 0.230)房颤发作是隐匿的,其中实验组无症状房颤检出率更高(实验组26.5%,对照组16.6%)。实验组首次房颤发作的中位诊断时间较对照组明显缩短(P = 0.039)。48例患者出现2次及以上房颤发作,实验组在房颤首次复发的中位诊断时间上也较对照组明显缩短(P = 0.001)。阵发房颤患者中实验组较对照组房颤平均持续时间缩短(P = 0.006),同时房颤负荷 >25%天数也明显缩短(P = 0.036)。69例患者中78.3%的患者CHA2DS2-VASc评分 ≥ 2分,但仅42%的患者接受抗凝治疗(实验组52.6%,对照组29%,P = 0.048)。结论:远程监测系统能够对房颤患者进行早期诊断与及时治疗,减少房颤持续时间、降低房颤负荷,可能给患者带来临床长远益处。Objective:To determine whether the remote monitoring system can diagnose and treat asympto-matic atrial fibrillation earlier.Methods:This was a single-center controlled trial,including 316 recipients with Germany Biotronic dual-chamber permanent pacemakers in Beijing Hospital,from April 2009 to April 2015.These 316 cases were divided into remote monitoring follow-up group(experimental group,RG)and routine clinical department follow-up group(control group,CG)according to the kinds of pacemakers;the mean follow-up time was 24.4±1.8 months;detection time,duration,AF burden and antithrombotic therapy were compared between the two groups.Results:69 patients experienced at least one episode of atrial fibrillation during the entire fol-low-up,yielding the occurrence rate of atrial fibrillation was 23.4%.89.9%patients have no symptoms,and it is easier to diagnose for experimental group.It was significantly shorter in the RG to detect the first atrial fibrillation episode(P=0.039).48 patients experienced two or more episodes,and the median time of first atrial fibrillation recurrence in RG was also shorter(P=0.001).The average duration of paroxysmal atrial fibrillation was shorter in RG(P=0.006).The average number of daily AF burden>25%was shorter in RG too(P=0.036).Only 42%patients undertook antithrombotic therapy(RG=52%vs CG=29%,P=0.048).Conclusion:Because of its real-time monitoring function,the remote monitoring system can detect earlier and treat timely in patients with permanent cardiac dual-chamber pacemakers,and thus by reducing the duration and burden of atrial fibrillation,may have a result of long-term clinical benefits.

关 键 词：心脏双腔起搏器 远程监测 房颤 体征和症状 临床应用 

分 类 号：R5[医药卫生—内科学]