摘要
目的 评价全自动远程家庭监测（HM）在植入心律转复除颤器（ICD）/心脏再同步治疗除颤器（CRT-D）患者中的应用.方法 随访23例植入了带有HM功能的ICD及CRT-D患者,分析HM所获得的日常信息和报警数据,观察其对系统相关事件、心律失常和心力衰竭（心衰）监测在内的临床相关事件的早期监测及临床干预的疗效.结果 对23例患者随访122～937（452.1±262.2）d,共接收报警信息1 991次,发现异常事件1 481次,其中96.4％是临床相关事件,1.5％为系统相关事件,无信息传输事件占2.1％.系统相关事件多为感知异常,其中发现左心室导线脱位1例.临床相关事件中心律失常报警事件占84.7％[室上性心律失常和心房颤动（房颤）事件较多],心衰报警事件占15.3％,以静息时心率升高及心脏再同步治疗心室起搏百分比降低为主.根据HM系统报警信息,电话联络患者65例次,优化参数11例次,指导调整药物治疗方案18例次,4例患者入院治疗.结论 对于植入ICD/CRT-D的患者,HM系统是一项必要的、安全可靠的远程监测方法,可以及时识别起搏系统相关异常、发现临床相关事件,可指导对患者进行早期临床干预,优化随访管理,提高患者生活质量.
Objective To evaluate the benefit of Home monitoring （HM） system in patients with implantable cardioverter defibrillator （ICD） or cardiac resynchronization therapy defibrillator（CRT-D）.Methods Twentythree patients undergoing implantation of ICD or CRT-D with HM were enrolled,data automatically collected on a daily basis and alerts by HM were analyzed.Early detection and intervention effect of HM included arrhythmias or heart failure to clinical events and system related events.Results The mean follow-up duration was 122-937 （452.1±262.2） d,a total of 1 991 remote transmissions were received.Among these transmissions,1 481 abnormal events were reported,96.4% of events were clinical-related,and 1.5% were system-related,no transmissions by 2.1%.Most of the system-related events were abnormal sensing,and one loose electrode placement of left ventricular was detected.Clinical events included 84.7% arrhythmic events and 15.3% HF monitoring events.Alerts for HF monitoring including heart rate at rest were increasing and CRT pacing percentage was reduced.Through alerts of the HM,patients got physician advices by telephone in 65 times,parameters were optimized in 11 times,and treatment plan was adjusted in 18 times,and four patients were hospitalized again.Conclusion Remote monitoring is necessary and safe which could early detect the abnormal events in the patients with ICD or CRT-D.This system is helpful in making earlier clinical intervention,and optimizing follow-up management,it may improve quality of life.
出处
《中华心律失常学杂志》
2014年第1期69-73,共5页
Chinese Journal of Cardiac Arrhythmias
关键词
远程家庭监测系统
心力衰竭
心脏再同步治疗
植入型心律转复除颤器
Home monitoring system
Heart failure
Cardiac resynchronization therapy
Implantable cardioverter defibrillator
