Comprehensive Evaluation of Rhythm Monitoring Strategies in Screening for Atrial Fibrillation: Insights From Patients at Risk Monitored Long Term With an Implantable Loop Recorder
Comprehensive Evaluation of Rhythm Monitoring Strategies in Screening for Atrial Fibrillation: Insights From Patients at Risk Monitored Long Term With an Implantable Loop Recorder
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DOI：
10.1161/circulationaha.119.044407
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发表时间：
2020-05-12
期刊：
影响因子：
37.8
通讯作者：
Svendsen, Jesper Hastrup
中科院分区：
文献类型：
--
作者：
Diederichsen, Soren Zoga;Haugan, Ketil Jorgen;Svendsen, Jesper Hastrup
背景：脑卒中是一个日益严重的全球性健康问题。房颤（AF）是中风的主要危险因素，随着新的监测技术的出现，对AF筛查的关注正在上升。我们的目的是评估一个大面板的筛选策略的性能，并评估人口特征与诊断yield.METHODS：个人与中风的危险因素，但没有AF招募从一般人群进行筛选与植入式循环记录仪。由高级心脏病专家判定新发AF持续时间≥ 6分钟。在连续监测>3年后，为每个参与者重建完整的日常心律数据集，包括所有AF发作的确切发作时间和终止时间。采用随机抽样的方法，以植入式循环记录仪为对照，评估各种模拟筛查策略的筛查敏感性和阴性预测值。跨策略和人口亚组的诊断率进行了比较，通过使用非参数tests.RESULTS：的节奏数据集包括590名参与者持久共659758天的连续监测和20110 AF发作。在这些数据中，单个10秒ECG产生的灵敏度（和阴性预测值）为1.5%（66%）的AF检测，在14天内每天两次30秒ECG增加到8.3%（67%），并增加到11%（68%），13%（68%），15%（69%），21%（70%），24小时、48小时、72小时、7天或30天连续监测分别为34%（74%）。当进行后续筛查时，或与单个时段相比，当相同的监测持续时间分布在多个时段时，AF检测进一步改善（例如，3次24小时监测与1次72小时监测; P= 75岁，男性，CHADS（2）评分>2，或NT-proBNP（N-末端B型钠尿肽前体）>= 40 pmol/L，并且在基础房颤发作>= 24小时的参与者中与较短的房颤相比（P
BACKGROUND: Stroke is an increasing health problem worldwide. Atrial fibrillation (AF) is a major risk factor for stroke, and the attention given to AF screening is rising, as new monitoring technologies emerge. We aimed to evaluate the performance of a large panel of screening strategies and to assess population characteristics associated with diagnostic yield.METHODS: Individuals with stroke risk factors but without AF were recruited from the general population to undergo screening with an implantable loop recorder. New-onset AF lasting >= 6 minutes was adjudicated by senior cardiologists. After continuous monitoring for >3 years, complete day-to-day heart rhythm data sets were reconstructed for every participant, including exact time of onset and termination of all AF episodes. Random sampling was applied to assess the sensitivity and negative predictive value of screening with various simulated screening strategies compared with the implantable loop recorder. The diagnostic yield across strategies and population subgroups was compared by use of nonparametric tests.RESULTS: The rhythm data sets comprised 590 participants enduring a total of 659758 days of continuous monitoring and 20110 AF episodes. In these data, a single 10-second ECG yielded a sensitivity (and negative predictive value) of 1.5% (66%) for AF detection, increasing to 8.3% (67%) for twice-daily 30-second ECGs during 14 days and to 11% (68%), 13% (68%), 15% (69%), 21% (70%), and 34% (74%) for a single 24-hour, 48-hour, 72-hour, 7-day, or 30-day continuous monitoring, respectively. AF detection further improved when subsequent screenings were performed or when the same monitoring duration was spread over several periods compared with a single period (eg, three 24-hour monitorings versus one 72-hour monitoring; P= 75 years, male sex, CHADS(2) score >2, or NT-proBNP (N-terminal pro-B-type natriuretic peptide) >= 40 pmol/L and among participants with underlying >= 24-hour AF episodes compared with shorter AF (P