Theo dõi điện tâm đồ truyền thống (holter), lâu dài (loop) hay từ xa (tele) biện pháp nào sẽ có ý nghĩa hơn cả

EKG monitoring : Holter, loop recorder or telemedicine should be relevant DR SOFIAN JOHAR CONSULTANT CARDIOLOGIST AND ELECTROPHYSIOLOGIST RIPAS HOSPITAL AND GLENEAGLES JPMC BRUNEI DA

EKG monitoring : Holter, loop

recorder or telemedicine should be

relevant

DR SOFIAN JOHAR CONSULTANT CARDIOLOGIST AND

ELECTROPHYSIOLOGIST RIPAS HOSPITAL AND GLENEAGLES JPMC

BRUNEI DARUSSALAM

– May be useful when patients are not too

symptomatic during episodes

– Can transmit over telephone lines

Implantable loop recorders

• Implanted subcutaneously

– Examples include

• Medronic

– REVEAL – LINQ

• St Jude

– Confirm

• Batteries last 2-3 years

• Useful when symptoms are intermittent or

when prolonged monitoring is required

Indications for ambulatory monitoring

– Evaluation in patient with unexplained stroke

– Monitoring atrial fibrillation ablation

Indications for Ambulatory ECG to

assess symptoms possibly related to

rhythm disturbances

• Class I

– Patients with unexplained syncope, near syncope

or episodic dizziness in whom the cause is not

– Patients with symptoms such as syncope, near

syncope, episodic dizziness, or palpitation in whom a probable cause other than arrhythmia has been

identified but in whom symptoms persist despite

treatment if this other cause

• Class III

– Patients with symptoms such as syncope, near

syncope, episodic dizziness, or palpitation in whom other causes have been identified by history,

physical examination or laboratory tests

– Patients with CVA, without other evidence of

arrhythmia

Assessment of risk in patients without

symptoms of arrhythmias

• After myocardial infarction

• Congestive heart failure

• Genetic heart disorders

Indications for AECG

• Efficacy of anti-arrhythmic drug therapy

• Assessment of pacemaker and ICD function

– Less necessary with use of modern devices

• Monitoring for myocardial ischaemia

Implantable loop recorders

Current Report: Trends

Patient: SURAINI SHARIL Received: 08-Oct-2016 00:05:00

SURAINI SHARIL 14 Month Cardiac Compass10-Aug-2015 to 08-Oct-2016

Longest AF (last 14 months): (ID# 633) 05-Nov-2015, Duration: 04:38:00

Medtronic CareLink Network LNQ11 Serial Number: RLA706048S 08-Oct-2016 17:43:41 Copyright © 2001-2016 Medtronic, Inc Patient ID: G-009269 1 / 1

Which to choose?

• Choice depends on nature of symptoms

– Holters are very cheap

– Yield is low

• With intermittent symptoms

– External loop recorders / event recorders probably more useful

• Implantable loop recorders

– Very useful for prolonged monitoring

– Small risk of infection

Diagnostic yield

• Syncope (1-26%)

• Palpitations (0-44%)

Palpitations

Peter Zimetbaum, and Alena Goldman Circulation

2010;122:1629-1636

Syncope

Peter Zimetbaum, and Alena Goldman Circulation 2010;122:1629-1636

may be as high as 12% per year

• Because anticoagulant treatment dramatically reduces the

recurrence rate, detection of this arrhythmia after stroke is

essential

• Unfortunately, AF remains underdiagnosed as it is often

asymptomatic: up to 30% of patients with AF are unaware of their diagnosis

• 25% of those with AF-associated stroke have no prior diagnosis of

AF

• AF pattern is intermittent in 30% of patients with stroke and may

not appear on a single recording

AF and stroke

• The AF detection rate with 12-lead ECG ranges between 2 and 5% after ischemic stroke or

transient ischemic stroke (TIA)

• 2 and 6% if a 24-hour Holter device is used

EMBRACE CRYSTAL-AF

Median CHADS2 Score of all

Hypertension in intervention

Diabetes mellitus in intervention

Monitoring device in

intervention group

30 day event-triggered loop recorder from Braemar (ER910AF Cardiac Event Monitor)

insertable cardiac monitor from Medtronic (REVEAL XT) Invasive insertion of device

Primary endpoint

newly detected AF lasting >30s

within 90 days after randomisation

time to first detection of AF (lasting >30s) within 6 months

EMBRACE CRYSTAL-AF CRYSTAL-AF CRYSTAL-AF

Phase 2

• The overall atrial fibrillation detection yield after all phases of sequential cardiac monitoring was 23·7% (95% CI 17·2–31·0)

• Stopping screening after phase 2 or phase 3

would have resulted in post-stroke atrial

fibrillation diagnosis in 50·2% (*7·7 + 4·2+ / 23·7)

or 81·9% (*7·7 + 4·2 + 7·5+ / 23·7), respectively, of those who would have been diagnosed after four phases