Key result
72-hour ECG detects ~60% more high-grade VPCs than 24-hour monitoring in post-MI patients.
Why the study?
Long-term ECG registration improves detection of rhythm and conduction disturbances and assesses autonomic regulation, prompting evaluation of the advantages of 72-hour telemetric ECG monitoring in patients with myocardial infarction.
Does long-term telemetric ECG monitoring for 72 hours improve the detection of arrhythmic events and electrical instability compared to standard 24-hour ECG monitoring in ICU patients with myocardial infarction?
Observational (n=114)
Does long-term telemetric ECG monitoring for 72 hours improve the detection of arrhythmic events and electrical instability compared to standard 24-hour ECG monitoring in ICU patients with myocardial infarction?
Long-term 72-hour telemetric ECG monitoring significantly improves the detection of clinically significant rhythm and conduction disorders in the early period after myocardial infarction compared to standard 24-hour monitoring.
Extended monitoring may enhance post-MI arrhythmia detection; hypothesis-generating and should not yet change practice.
The latest technologies of long-term ECG registration improve detection of rhythm and conduction disturbances, as well as comprehensively assess autonomic regulation of heart rhythm. Objective. To identify the advantages of long-term telemetric ECG monitoring for 72 hours (TMM72 ECG) for recording arrhythmic events, episodes of conduction disturbances, as well as for evaluating the parameters of electrical instability in patients with myocardial infarction (MI). Material and methods. The study included 114 ICU patients aged 58 (52; 62) years with MI. TMM72 Nehb 3-lead (A, D, I) ECG was performed using the ASTROCARD®-TELEMETRY telemetry complex for 72 hours from the 4th day after MI. We assessed frequent and paired supraventricular premature contractions, supraventricular tachycardia (SVT), ventricular arrhythmias Lown—Wolf grade ≥3, sinoatrial and atrioventricular (SA- and AV-) blockages, paroxysms of atrial fibrillation. Chronotropic load (CL), heart rate variability (HRV), heart rate turbulence (HRT), microvolt alternation of T wave (MAT), late ventricular potentials (LVPs), and QT interval variance were evaluated. The transmitted data were analyzed at the end of each day of monitoring, and then we estimated certain time intervals (24, 48 and 72 hours). Results. The number of patients with frequent supraventricular premature contractions increased by 13.1% (p=0.04), paired supraventricular premature contractions by 22.7% (p=0.001) and SVT by 21% (p=0.003) compared to standard 24-hour ECG monitoring. Ventricular premature contractions Lown—Wolf grade ≥3 were registered in 65 patients (57%) that is 1.6 times higher compared to standard 24-hour ECG monitoring (p=0.031). SA- and AV- blockages grade 2 were 2 times more common (p=0.044). Impaired HRT was detected in 32.5% and 15.8% of cases, respectively (p=0.06). The number of patients with MAT increased by 14.9% (p=0.021) after 72 hours of continuous monitoring. CL Sa demonstrated total decrease from 1.07 (0.26; 3.8) on the first day to 0.94 (0.26;4.2) (p=0.022) by the end of TMM72 ECG. HRV parameters positively changed by the end of monitoring: TotP — by 46% (p=0.001), ULfP — by 47% (p=0.001), LfP — by 43% (p=0.001), HfP — by 37% (p=0.001), L/H increased by 49% (p=0.001). Conclusion. TMM72 ECG significantly improves detection of clinically significant rhythm and conduction disorders. This method is valuable for comprehensive assessment of autonomic regulation of heart rhythm and markers of myocardial electrical instability in early period after MI.
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Oleynikov et al. (2024) conducted an observational in myocardial infarction (n=114). Long-term telemetric ECG monitoring for 72 hours (TMM72 ECG) vs. Standard 24-hour ECG monitoring was evaluated on Detection of ventricular premature contractions Lown-Wolf grade ≥3 (p=0.031). Long-term 72-hour telemetric ECG monitoring detected ventricular premature contractions Lown-Wolf grade ≥3 in 57% of MI patients, 1.6 times higher than standard 24-hour monitoring (p=0.031).
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