Clinical Application Of Long Electrocardiogram With Long Duration

PART ⅠClinical practice of very long-term ECG monitoring for ar-rhythmiaObjective:To investigate the application of long-attached ambulatory electrocardi-ographic recorder and software (Smartpatch) for arrhythmia diagnosis.Methods:From January 2015 to July 2015,30 cases of arrhythmia patients (aged 48.78±18.41years, 10 female) treated in our hospital were enrolled. Each patient had the Smartpatch monitoring for 14 days after routine 24h Holter monitoring. The arrhythmia detection rates were compared and the types of arrhythmia were analyzed.Results:Four cases were detected arrhythmia and the arrhythmia detection rate of Holter was 13.3%; Twenty-six cases were detected arrhythmia and the detection rate of smartpatch was 86.7%(P<0.05)Conclusion:It is more convenient, effective to practice smartpatch in arrhythmia detection compared with routing Holter recording.PART ⅡApplication of Very Longterm electrocardiographic moni-toring in Detecting the Long RR Interval.Objective:To investigate the clinical value of long-attached ambulatory electrocar-diographic recorder and software (Smartpatch) in RR long interval diagnosis.Method:Select 93 patients who came to our hospital from Jan.1st 2015 to Jan.31st 2016 with clinical manifestations of syncope, dizziness, amaurosis and palpitation, in which there are 52 male patients (accounts for 55.9%) and 41 female patients at ages of 53.3±17.3years. Each patient had the Smartpatch monitoring for 14 days make data play back and analysis.1. Choose patients with RR intervals> 2s and make further analysis from time, age, gender, arrhythmia, seriousness degree of long RR interval, heart rate variability and other aspects.2. Patients with RR interval>2s were selected out. And the time points of daily long RR interval were recorded (every hour) and the patients with the long RR interval at the same time were selected out for analysis. Further analysis was conducted on age, gender, type of arrhythmia, serious degree of long RR interval, time point of long RR interval repeatability, heart rate variability, etcResult:Smartpatch diagnosed that there are 28 patients with≥2s RR long interval and detection rate is 30.1%, in which there are 17 males (accounts for 61.7%), average age at 55.8±17.9years, average wearing time at 14.12±3.13d, effective recording time at 10.33±3.56d,16 cases of sinus arrest have been detected,8 cases of atrial fibrillation or RR long interval in atrial flutter have been detected,4 cases of second degree atrioven-tricular block. Longest RR long interval is 4257ms. Long RR interval has obvious circa-dian rhythm, which attacks most frequently at night. The attack cases per hour of long RR interval at night reached over 40% and the frequency per hour of long RR interval at night reached over 10%. The cases and frequency of long RR interval at night (24-5) were the most, the cases occupying 89.3% and the frequency proportion occupying 71.4%; comparing with the afternoon (12-7) period, the difference had statistical signifi-cance. When 24 hours were further divided into day 12h and night 12h, the attacks at night were still the most, the attack cases occupying 82.1%; comparing with that in the daytime, it had statistical difference. From the serious degree of long cause,2-3 S inter-vals at long RR period were the commonest, the attack cases occupying 96.4%, the attack frequency occupying 99.8%, they all had statistical difference.Patients wearing Smartpatch were divided into long RR interval group (28 cases) and normal control group (65 cases) and analysis was conducted on HRV related time-domain indexes and frequency-domain indexes. From the time-domain indexes, the data obtained from Smartpatch analysis were all higher than that of the normal reference range and the control group and comparing NN interval (long RR interval group 951.25 ± 192.28ms), SDNN (long RR interval group 162.93±63.49ms), RMSSD (long RR in-terval group 82.54 ±71.25ms), PNN50 (long RR interval group 17.54±11.08%) with NN interval (control group 859.53±108.25ms), SDNN (control group 132.71± 39.67ms), RMSSD (control group 44.55±35.17ms), PNN50 (control group 11.37± 10.24%) of the control group, it had statistical difference. Comparing the frequen-cy-domain indexes, TP, VLF, LF, HF were all higher than that of the control group. The comparison of HF between long RR interval group (352.64±521.05 ms2) and the con-trol group (212.66±291.3 ms2) had statistical difference. It is thought that the time dis-tribution of long RR interval group was related to autonomic nervous regulation.Conclusion:It is safe and efficient to use Smartpatch in the long RR interval diag-nosis. It can not only make up for the insufficiencies of Holter such as short monitoring window time, missed diagnosis, etc., but can also record the onset rule of arrhythmia by recording the onset time of arrhythmia, so as to provide clinical evidence for the treat-ment of arrhythmia.