Telemetry of high-risk patients with cardiovascular diseases
Prof. Ivo Iliev, DSc – TU-Sofia Ass.prof. Krasimira Kostikova– MU-Sofia
Target groups of patients indicative of telemetry
•Patients with left ventricular dysfunction
•Patients with symptomatic conduction dysfunctions
•Patients with Implantable Pacemakers (PM), who need of post-operative monitoring and control
•Patients with Ischemic Heart Disease or survived after Myocardial Infarction •Patients with Ischemic Heart Disease and diabetes •Patients with flutter
•Patients after transplantation
Algorithms verification MIT-BIH, AHA and European ST-T databases are used
База данни Se [%]
PPV [%]
TP beats
FN beats
FP beats
FPH beats
MIT-BIH 99.37 99.51 208701 1315 1033 21.5
AHA 99.32 99.66 322328 2205 1085 15.5
European ST-T 99.85 99.54 836750 1271 3850 20.1
Общо за трите 99.65 99.57 1367779 4791 5968 19.3
Нормални NBs Камерни екстрасистоли VBs
Коректни бр.
Грешни бр.
Sp [%]
Коректни бр.
Грешни бр.
Se [%]
•MIT-BIH
Пълна база данни 174000 1675 99.05 12454 591 95.47
Noise free 172045 180 99.9 12209 81 99.34
•AHA
Пълна база данни 310982 3584 98.86 28207 1182 95.98
Noise free 291936 1131 99.61 23475 184 99.22
Cardiovascular and cerebrovascular
diseases are a leading cause for death and disablement worldwide. This global epidemic affects all regions in the world.
Cardiovascular diseases (CVD) are a major cause for premature death in Europe. They are a leading cause for disablement and contribute to a large extent to growing healthcare expenses.
CVD death is often unexpected and occurs before medical help is rendered. That’s why a lot of therapeutic interventions are either inapplicable or palliative.
• CVD: • Ischemic heart disease – angina and myocardial
infarction • Cerebrovascular disease (stroke and transient
ischemic attack) • Peripheral vascular disease • Hypertension • Valvular and congenital heart disease • Rhythm and conduction disorders • Congestive heart failure
AF may lead to: • Death – mortality rate is twice as high in patients with AF
as compared to patients without AF • Stroke
– Every 4th stroke is caused by AF – Embolic stroke caused by AF is graver and with a worse
prognosis • Heart failure and acute coronary syndrome - greater
incidence of HF and ACS in patients with AF (N England Journal Of Medicine 2010,362:1363- 73)
• Cognitive dysfunction – asymptomatic embolic incidents accompanied by AF worsen the cognitive function (Eur Heart J 2008; 29 2125-2132)
12-lead ECG remains the gold standard for
arrhythmia detection, the major drawback of the method being the lack of early detection in asymptomatic patients.
Recent research has shown that more frequent rhythms monitoring raises the cases of AF detection. However, the appliances required are expensive and inconvenient. Due to these impediments, the National Health, Heart, Lung, and Blood Institute guidelines emphasize the need for a new method for AF detection. (Circulation 2009;119:606–618.)
Objective:
To analyze the data received from the
telemetry ECG monitoring system applied to patients with rhythm and conduction disorders
Material and methods:
We applied a telemetry ECG monitoring system to 42 patients (28female and 14male) treated in the Cardiology Department of the Clinic of Propedeutics of Internal Diseases, University Hospital Alexandrovska, Sofia, for the period of 3months (from June 2013 to September 2013). Patients in the following groups were included:
Materials and methods:
• 9 patients with ischemic heart disease and
surviving a myocardial infarction (3 female, 6 male)
• 8 patients with ischemic heart disease – without a MI (4 female and 4 male)
• 25 patients at high risk (18 female and 4 male): patients with arterial hypertension, heart failure (associated with valvular heart disease or cardiomyopathy), myopericarditis, accompanying thyreopathology and patients with accompanying electrolyte disbalance
Results:
Using the device we registered different cases of:
• Rhythm disorders – atrial (37 episodes) and ventricular (23 episodes) extrasystoles, supraventricular tachycardia (3 episodes), episodes of atrial fiblillation (10)
• Conduction disorders – AV block I degree (2) and SA block (1)
The telemetry monitoring system showed very good efficacy and tolerability in all 42 patients. The total number of 76 episodes of rhythm and conduction disorders registered permitted a timely therapeutic intervention, especially in the cases when there was an impediment for standard holter ECG monitoring.
No serious technical failures or malfunctions
in the telemetry system were observed during the period of follow-up.
The follow-up of the patients in the Cardiology Department of the Clinic of Propedeutics of Internal Diseases “Prof. St. Kirkovich”through telemetry monitoring is on-going. The results from the system described are to be analyzed through a parallel comparison with the data from the holter ECG monitoring, the morphological echocardiogram evaluation, including the patient’s risk profile, as well as the factor time to event and possibility for intervention.
The application of the telemetry ECG monitoring system is a novel, convenient non-invasive technology for a complete 24-hour uninterrupted ECG monitoring and control of the patient outside the intensive care ward which allows for immediate emergency reanimation procedures. Its benefits for routine use in the clinical practice are doubtless.
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