The Feasibility And Effect Of Remote ECG Monitoring In Arrhythmia Diagnosis And Therapy

Background:Limited data has shown the clinical efficacy of the remote ECG monitoring (REM) on arrhythmia analysis and treatment. The current study tested the feasibility and effect of REM to diagnosis arrhythmia by the comparison with12-lead electrocardiogram (ECG) and Ambulatory electrocardiogram (Holter). At the same time, we also further evaluated their advantage and disadvantage in the early follow-up after anti-arrhythmic therapy including drug, radiofrequency catheter ablation (RFCA) and pacemaker implantation.Methods:Part Ⅰ:142patients with complains of chest distress, palpitation, dizziness and syncope were included in this research. During the follow-up.period, all patients underwent REM for a period from one week to one month and al least three ECG. Meanwhile,72of them received Holter examination. The positive rates among3kinds of ECG diagnostic mode were compared. Part2:①REM for follow-up after anti-arrhythmic therapy were enrolled into92sympthic patients including38cases with frequent premature ventricular contractions (VPBs) or short paroxysmal ventricular tachycardia (PVT) and54with frequent atrial premature beats (APBs) or rapidity Atrial arrhythmia such as atrial fibrillation (Af), Atrial flutter (AF) and atrial tachycardia (AT). Anti-arrhythmia drugs such as mexiletine, propafenone, amiodarone, metoprolol and Buchangwenxin granules were selected. During the follow-up period of3months, all patients were monitored by REM for1week to1month. REM was carried out in a specific time daily and the symptoms during moniting. ECG and Holter were performed each of the at least1times after first weeks and during3months.②This study also included143patients who had underwent RFCA. Among of them,93of them were paroxysmal supraventricular tachycardia (PSVT), including12type B pre-excitation syndrome patients and16type A pre-excitation syndrome,24paroxysmal atrial fibrillation (PAF),4paroxysmal atrial tachycardia (PAT),16frequent VPBs and6VTs. They were recorded ECG by REM at the time when they feel uncomfortable during the follow-up of two weeks to one month period. All patients underwent ECG and Holter examinations at one week and one month after operation. The arrhythmia detection rate was tested in patients with RFCA by REM.③. The study also included122patients with pacemaker implantation. Among of them,64were SSS,38were Ⅲ°AVB,10were AF with high degree AV block,7were DCM with LBBB and3were VT. There were14ⅤⅤⅠ cases,98DDD cases,3ICD cases,7CRT or CRTD cases. REM were performed in patients with pacemaker implantation and the method was similar to the patients with RFCA. The arrhythmia detection rate was tested in patients with pacemaker implantation by REM.Result:1. Ten cases were excluded from the study. There were6945effective REM in132patients. Among of them,105arrhythmia cases and30ST-T change cases were detected by REM, while76arrhythmia cases and26ST-T change cases were detected by ECG. Statistic analysis show that REM have a higher value to detect arrhythmia (P<0.05). However, there were no significant difference in the value of detecting ST-T changes between the two (P>0.05). In72cases who had underwent Holter, REM had detected62arrhythmia cases and21ST-T change cases, while Holter detected52arrhythmia cases and25ST-T change cases, Statistic analysis show that REM have a higher value to detect arrhythmia than Holter (P<0.05). However,there were no difference in the value of detecting ST-T changes between the two (P>0.05).2.①6in92patients who had underwent anti-arrhythmia drugs were lost. REM got7643effective ECG image in86patients. REM found that45cases who were effective for drugs and10cases who had side effect of drugs,while ECG and Holter found that60cases who were effective for drugs and4cases who had side effect of drugs. Statistical resultss showed that there are significant differences between the two (P<0.05).②In the follow up of143RFCA cases, REM got6843effective ECG images. Among them there were6162normal cases,1654of them were accompanied by symptoms.There were681abnormal cases,167of them did not accompanied by symptoms. REM found13recurrence cases, including2PSVT cases,6AF,2AT,3VP. ECG only found6recurrence cases, including3AF cases,1AT cases,2VP cases, Holter found that there were9recurrence cases, including4AF cases,2AT cases,3VP cases. Statistical results showed REM have a higher value in finding recurrence cases than ECG and Holter (P<0.05).③In the follow up of122after pacemaker implantation cases, REM got5238effective ECG images. Among them there were4359normal cases,879abnormal cases, REM found8VPBs cases,4APBs cases,8PAF and PAT cases, ECG and Holter found2VPBs cases,3APBs cases,2PAF and PAT cases, REM found one pacemaker malfunction cases, which proved to be Left ventricular electrode micro dislocation later.Conclusion:1.REM is more effective than ECG and Holter in detecting arrhythmia which happened outside hospital.2.①REM can in time evaluate the effect and side effect of anti-arrhythmia drugs.②REM can detect recurrence after RFCA more effectively than ECG and Holter. so it is wise to make it a routine examination to patients who have underwent RFCA, especially in AF patients. REM is also more effective in following up patients who have underwent pacemaker implantation.③REM can detect intrinsic arrhythmia and new arrhythmia in patients underwent pacemaker implantation. REM can find pacemaker malfunction and poor sensitivity cases, so it is also wise to make it a routine examination to patients who have pacemaker implantation. Otherwise, REM have many advantages, it is cheap,and can detect arrhythmia anytime and anywhere comparing to ECG and Holter. REM may detect malignant arrhythmia and sudden cardiac arrest effectively, so it is palying more and more important roles in the treatment of patients with arrhythmia.