Key result
120-hour ECG monitoring linked to ~2.2-fold higher detection of life-threatening arrhythmias vs 24-hour monitoring post-STEMI.
Why the study?
Standard 24-hour ECG monitoring has disadvantages in detecting episodes of unstable life-threatening arrhythmias, prompting evaluation of whether longer monitoring (48-120 hours) improves detection of arrhythmic events and electrical instability in STEMI.
Does long-term multi-day ECG monitoring improve the detection of life-threatening arrhythmias compared to standard 24-hour monitoring in patients with STEMI?
Cohort (n=71)
No
Does long-term multi-day ECG monitoring improve the detection of life-threatening arrhythmias compared to standard 24-hour monitoring in patients with STEMI?
Extending continuous ECG monitoring up to 120 hours in the early post-infarction period more than doubles the detection rate of clinically silent, life-threatening arrhythmias.
Answers are grounded in this paper and cite their sources.
Extended ECG monitoring detects more arrhythmias post-STEMI; hypothesis-generating and should not yet change practice.
Background. In modern cardiology, 24-hour electrocardiogram (ECG) monitoring has a high diagnostic value, but this method has a number of disadvantages in detecting episodes of unstable life-threatening arrhythmias. An increase in ECG monitoring duration allows expanding the possibilities of diagnosing life-threatening arrhythmias. Objective. To study the possibilities of long-term ECG monitoring (48–120 hours) in the detection of life-threatening arrhythmic events and parameters of myocardial electrical instability in patients with ST-segment elevation myocardial infarction (STEMI). Design and methods. The study included 71 STEMI patients. All patients from the 4th day of STEMI underwent multi-day ECG monitoring in 3 leads using a telemetric ECG recording complex with an average recording duration of 90.4 ± 30.2 hours. The analysis of episodes of myocardial ischemia, rhythm and conduction disturbances, turbulence and heart rate variability, late ventricular potentials and dispersion of the QT interval within 5 days was carried out. Results. Long-term monitoring allowed detecting high-grade ventricular extrasystoles. Analysis of episodes of myocardial ischemia in the postinfarction period revealed significant differences in the data of 120h-ECG monitoring in comparison with 24h-ECG. Multiday ECG monitoring made it possible to detect dysfunction of the autonomic regulation of cardiac activity in patients 2 times more often. Conclusion. A comprehensive assessment of the possibilities of multi-day ECG monitoring is a promising direction in predicting severe arrhythmias in patients in the postinfarction period.
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Oleynikov et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=71). Long-term multi-day ECG monitoring vs. Standard 24-hour ECG monitoring was evaluated on Detection of life-threatening arrhythmias (Lown-Wolf grade 4A and above) (p=0.009). Long-term ECG monitoring for 120 hours significantly increased the detection of life-threatening arrhythmias compared to standard 24-hour monitoring in patients with STEMI (38.0% vs 16.9%, p=0.009).
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