The Clinical Study Of Applying Wireless Remote ECG Monitoring In The Diagnosis And Treatment Of Patients With Arrhythmia

Objective:The study is to explore the clinical diagnosis and treatment of wireless remote ECG monitoring (REM) for suspected arrhythmia patients whose routine examination cannot duly record the electrocardiogram when symptoms attack and investigate its safety, effectiveness as well as technical essentials, in order to provide scientific basis for expanding the further application of wireless REM outside of hospital and in family.Methods:121 cases who were highly suspected arrhythmia patients whose routine examination can not timely record the electrocardiogram when symptoms attack were collected from out-patient or in-patient from July 2014 to March 2016 in the first Affiliated Hospital of Kunming Medical University,including 67 males,54 females, aged 14～87 years, average age was 50.88±13.38years. Patients were selected by ECG Holter,Echocardiography, Exercise testing, Coronary artery CT. Among all cases,60were diagnosed as cardiovascular disease,including 25 cases with hypertension,18 with coronary heart disease,10 with myocardiosis,5 with Congenital heart disease,2 with Rheumatic heart disease and 61 patients without heart disease. All patients used REM to collect and transmit the ECG regularly for three times a day. when there is a symptom, ECG data were collected and transmitted at once.Result:There were 5647 ECG images in 121 patients,including 5142 effective ECG images in 7-30 days(average 11.5 days).Among of them,47arrhythmia cases were detected by wireless REM,including,19cases with nodal tachycardia,4 with atrial premature beat,3 with sinus bradycardia,2 with paroxysm atrial fibrillation,4 with paroxysmal supraventricular tachycardia,1 with high grade A-V block,3 with Paroxysmal Atrial Tachycard,2 with First degree A-V block,3 with type 1 second degree A-V block,11 with ventricular premature beats,4with ventricular tachycardia,1 with WPW syndrome. Among them,3 cases of these patients with sinus bradycardia were detected, who were regularly performed on ECG transmission by REM and the cases had no symptom when being followed up, so no treatment was given; 4 cases of patients with history of syncope symptoms, one case of intermittent III atrioventricular block was detected, with no occurrence of syncope symptoms after pacemaker implantation.2 cases were diagnosed as vasovagal syncope by REM,elephone follow-up, blood pressure monitoring and other methods. The syncope symptom of one patient was unknown.1 case was intermittent pre-excitation syndrome, with no attack of tachycardia during the monitoring period, so no administration was given.11 cases of patients with recurrent palpitation, who were detected sinus tachycardia by multiple transmit ECG of REM during monitoring period, according the follow-up and combination with their clinical symptoms, were diagnosed as cardiac neurosis. After administrated with psychological counseling and treated with Preceptor blocker as appropriate, the symptoms of above patients had significantly alleviated; 1 patient, who attacked amaurosis fugax during monitoring period, was detected by electrocardiogram transmission in time, with the result of ventricular tachycardia, was taken with ICD implantation, then no amaurosis fugax recurred. Palpitations, dizziness and other symptoms were detected in 4 cases of patients with paroxysmal supraventricular tachycardia. When treated with radiofrequency ablation, the above symptoms have no recurrence. The rest of patients with arrhythmia did not give administration.Conclusion:1、The wireless REM system CG-2100 can safely and quickly collect and clearly transmit ECG of patients onset in real time without attached electrode, which will increase medication compliance and is especially suitable for long-distance REM out of hospital.2、The wireless REM has important diagnostic value in highly suspected arrhythmia patients whose onset ECG can not be collected by routine examination and short-term hospitalization bedside monitoring,especially for patients with low frequency,long interval and short duration onset.3、The wireless REM cooperate with telephone follow-up and onset home blood pressure monitoring can make a diagnosis to unexplained syncope or near syncope,and make further differential diagnosis to arrhythmic syncope or vasovagal syncope.4、The wireless REM has high diagnostic value in patients with cardiac neurosis and vegetative nerve functional disturbance,and can cooperate with telephone follow-up psychological service and medication which has better clinical therapeutic effect.5、The chest leads (v5 leads)ECG of the wireless REM have less interference and better quality than limb leads(I leads)ECG which make it a better option for recogniton of ECG and diagnosis of arrhythmia,therefore,it is recommended to use ECG collection by chest leads or ECG joint collection by chest leads and limb leads.