CAJ | 학술논문

目的通过电话心电远程监测心房颤动（房颤）射频消融术后复发情况，探讨远程心电监测仪诊断心律失常的临床价值。方法自2009年10月至2010年4月在我院行房颤射频消融术患者72例，其中持续性房颤39例、阵发性房颤33例。患者在消融术后第1天及每3个月均接受24 h动态心电图检查，同时术后每天定时及有症状时接受电话远程传输心电图（TTECG）监测。比较两种检测方法记录的房颤复发情况及房颤发生与症状的相关性。结果随访(11.0±2.3)个月，TTECG共检测到4403份无干扰心电图，3610份窦性心电图中有症状的1351份(37.43％)。793份异常心电图中无症状性发作的214份(26.99％)。术后3个月空白期中，24h动态心电图发现17例(23.61％)房颤复发，TTECG发现31例复发，差异有统计学意义(P=0.004)。随访期间，24h动态心电图发现9例房颤患者复发，TTECG发现18例复发，差异有统计学意义(P=0.033)。通过TTECG的监测，与空白期的复发率比较，1年后房颤复发率明显下降(P=0.022)，而24h动态心电图未发现复发率的差异(P=0.083)。通过24h动态心电图及TTECG监测，持续性房颤消融成功率分别为84.62％，71.79％ (P=0.000)，阵发性房颤消融成功率分别为90.91％，78.79％ (P=0.006)。结论对于心律失常尤其是射频消融术后房颤的监测，电话远程心电监测优于常规24h动态心电监测，能及时发现术后房性心律失常复发，尤其是无症状性房颤。术后有症状患者也不一定是真正的房颤复发，实际为窦性心律。
목적 통과전화심전원정감측심방전동（방전）사빈소융술후복발정황，탐토원정심전감측의진단심률실상적림상개치。방법 자2009년10월지2010년4월재아원행방전사빈소융술환자72례，기중지속성방전39례、진발성방전33례。환자재소융술후제1천급매3개월균접수24 h동태심전도검사，동시술후매천정시급유증상시접수전화원정전수심전도（TTECG）감측。비교량충검측방법기록적방전복발정황급방전발생여증상적상관성。결과 수방(11.0±2.3)개월，TTECG공검측도4403빈무간우심전도，3610빈두성심전도중유증상적1351빈(37.43％)。793빈이상심전도중무증상성발작적214빈(26.99％)。술후3개월공백기중，24h동태심전도발현17례(23.61％)방전복발，TTECG발현31례복발，차이유통계학의의(P=0.004)。수방기간，24h동태심전도발현9례방전환자복발，TTECG발현18례복발，차이유통계학의의(P=0.033)。통과TTECG적감측，여공백기적복발솔비교，1년후방전복발솔명현하강(P=0.022)，이24h동태심전도미발현복발솔적차이(P=0.083)。통과24h동태심전도급TTECG감측，지속성방전소융성공솔분별위84.62％，71.79％ (P=0.000)，진발성방전소융성공솔분별위90.91％，78.79％ (P=0.006)。결론 대우심률실상우기시사빈소융술후방전적감측，전화원정심전감측우우상규24h동태심전감측，능급시발현술후방성심률실상복발，우기시무증상성방전。술후유증상환자야불일정시진정적방전복발，실제위두성심률。
Objective The aim was to investigate the clinical values of transtelephonic electrocardiogram (TFECG) monitoring system for heart arrhythmias diagnosis through its follow-up after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). Methods Seventy-two patients including 39 persistent AF and 33 paroxysmal AF patients received RFCA during Oct 2009-Apr 2010. All patients received 24-hour Holter examination on the first day after ablation and also every three months. Meanwhile TTECG were taken at regular time no matter patients have symptoms or not after ablation. The episodes of AF and the relationship of AF and sympotoms recorded by TTECG were compared with what Hoher recorded. Results Forty-four hundreds and three electrocardiograms (ECGs)were received by TTECGs totally. Among 3610 sinus rhythm ECGs, 1351 (37.43％) cases had symptoms. Among 793 abnormal ECGs, 214 ECGs were silent without any symptoms(26. 99％ ). At the end of three months of blanking period, 17 patients with AF recurrence were recorded by 24-hour Holter monitoring,31 patients were recorded by TTECG monitoring. There were significant differences between these two methods (P= 0. 004). During ( 11.0±2. 3) months of follow-up,9 patients with AF recurrence recorded by 24-hour Holter while 18 patients were recorded by TTECG monitoring (P=0. 033).Compared to the blanking period,recurrence rate after 1 year follow-up decreased significantly through TTECG monitoring( P= 0. 022), but no significant decreased by 24-hour Holter monitoring( P = 0. 083 ). Compared 24-hour Holter with TTECG monitoring,the successful rate for persistent AF ablation were 84. 62％ ,and 71.79％respectively( P = 0. 000 ), the successful rate for paroxysmal AF ablation were 90. 91％, and 78.79％ ( P =0. 006). Conclusion The results show the advantage of TTECG monitoring system in the following-up of patients after AF ablation, and it can detect asymptomatic AF after RFCA.