The diagnosis of cardiac arrhythmias: A prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring
The diagnosis of cardiac arrhythmias: A prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring
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DOI：
10.1111/j.1540-8167.2006.00729.x
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发表时间：
2007-03-01
影响因子：
2.7
通讯作者：
Kowey, Peter R.
中科院分区：
文献类型：
--
作者：
Rothman, Steven A.;Laughlin, James C.;Kowey, Peter R.
简介：动态心电图监测系统经常用于门诊患者心律失常症状的评估;然而，它们在识别临床显著但不常见、短暂和/或间歇性症状性心律失常方面的产率较低。本研究的目的是比较一个移动的心脏门诊遥测系统（MCOT）的相对价值与患者激活的外部循环事件监测器（LOOP）的症状被认为是由于心律失常。方法和结果：这项研究是一个17中心的前瞻性临床试验，患者随机分配到LOOP或MCOT长达30天。有晕厥、先兆晕厥或严重心悸症状且接受非诊断性24小时Holler监测的受试者被随机分组。主要终点是确认或排除其症状的可能病因。共分析了266例完成监测期的患者。88%的MCOT受试者和75%的LOOP受试者进行了诊断（P = 0.008）。在出现晕厥或晕厥前期的患者亚组中，MCOT受试者的诊断率为89%，LOOP受试者为69%（P = 0.008）。MOOT在确认临床显著心律失常的诊断方面具有上级优势，134例患者中有55例（41%）检测到此类事件，而LOOP组中有132例患者中有19例（15%）检测到此类事件（P < 0.001）。结论：在症状提示显著心律失常的患者中，MCOT的检出率明显高于标准心脏回路记录仪。
Introduction: Ambulatory electrocardiographic monitoring systems are frequently used in the outpatient evaluation of symptoms suggestive of a cardiac arrhythmia; however, they have a low yield in the identification of clinically significant but infrequent, brief, and/or intermittently symptomatic arrhythmias. The purpose of this study was to compare the relative value of a mobile cardiac outpatient telemetry system (MCOT) with a patient-activated external looping event monitor (LOOP) for symptoms thought to be due to an arrhythmia.Methods and Results: The study was a 17-center prospective clinical trial with patients randomized to either LOOP or MCOT for up to 30 days. Subjects with symptoms of syncope, presyncope, or severe palpitations who had a nondiagnostic 24-hour Holler monitor were randomized. The primary endpoint was the confirmation or exclusion of a probable arrhythmic cause of their symptoms. A total of 266 patients who completed the monitoring period were analyzed. A diagnosis was made in 88% of MCOT subjects compared with 75% of LOOP subjects (P = 0.008). In a subgroup of patients presenting with syncope or presyncope, a diagnosis was made in 89% of MCOT subjects versus 69% of LOOP subjects (P = 0.008). MOOT was superior in confirming the diagnosis of clinical significant arrhythmias, detecting such events in 55 of 134 patients (41%) compared with 19 of 132 patients (15%) in the LOOP group (P < 0.001).Conclusions: MCOT provided a significantly higher yield than standard cardiac loop recorders in patients with symptoms suggestive of a significant cardiac arrhythmia.