МНОГОСУТОЧНОЕ МОНИТОРИРОВАНИЕ ЭКГ С ТЕЛЕМЕТРИЕЙ - НОВЫЙ МЕТОД ДИАГНОСТИКИ РЕДКО ВОЗНИКАЮЩИХ СИМПТОМНЫХ АРИТМИЙ И СИНКОПАЛЬНЫХ СОСТОЯНИЙ

To clarify advantages of the method of long-term ECG monitoring, assess its diagnostic value with regard to rare arrhythmic events, and document its correlation (or lack of correlation) with clinical symptoms, 84 patients (27 women and 57 men) aged 48.3±22.6 years (7 months - 80 years) were examined. Twenty nine patients had arterial hypertension, 22 ones had coronary artery disease; cardiomyopathy of undetermined origin was diagnosed in 4 patients, dilated cardiomyopathy, in 2 ones, and hypertrophic cardiomyopathy, in 2 ones. The systemic connective tissue dysplasia was revealed in 1 patient, idiopathic pulmonary hypertension, in 1 patient, and syndrome X, in 1 patient. In 23 subjects, cardiac arrhythmias were considered idiopathic. Before long-term ECG monitoring, the patients were counseled in depth in ECG transfer through the Internet, the diary was given for recording subjective feelings, additional electrodes for replacement and recommendations for daily activities during long-term ECG monitoring were given, as well. The long-term ECG monitoring device with telemetric control was installed to study subjects, in which the system of 3 canal ECG recording of 7 leads was used. A laptop was also given to the study patients to be used for ECG upload into the server. When receiving the information on the server via the Internet, a physician analyzed it using the KTResult 3 software product. Indications to long-term ECG monitoring were as follows: symptomatic palpitations and painful irregular heartbeats, which were not recorded during previous Holter monitoring, in 69 patients and syncope/pre-syncope of unknown origin, in 15 patients. The duration of long-term ECG monitoring with the telemetric control was 7.9±3.2 days (4 39 days). During long-term ECG monitoring, the correlation of palpitations and irregular heartbeats with cardiac arrhythmias was documented in all 69 study subjects: ventricular tachycardia was documented in 31 subjects, paroxysmal atrial fibrillation/flutter, in 14 patients, paroxysms of sustained atrial tachycardia, in 8 subjects, and sinus tachycardia, in 16 patients. In 15 patients with complaints of syncope or pre-syncope, their correlation with cardiac arrhythmias was confirmed only in 5 cases. No complications during long-term ECG monitoring were documented. The authors’ experience in the long-term ECG monitoring gives evidence that a novel effective technique has been introduced which permits one to speed up the diagnosis of severe cardiac arrhythmia, contributes to confirmation/exclusion of arrhythmic origin of rare syncope and episodes of palpitations. This, in its turn, can contribute to selection of the optimal treatment strategy, including timeliness of surgical procedures (implantation of pacemakers and cardioverters-defibrillators, radiofrequency catheter ablation). The novel method will be indeed of importance in case of conservative management of arrhythmic patients.

многосуточное мониторирование, электрокардиограмма, телеметрия, нарушения ритма сердца, желудочковые тахикардии, синкопальные состояния

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