心房颤动射频消融术后远程心电监测随访的意义

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24h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，TrECG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。

The value of transtelephonic electrocardiogram monitoring system during follow-up after radiofrequency ablation for atrial fibrillation

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.