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

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。

Abstract: 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.