Home Monitoring to Identify Arrhythmia Concerns: The Promise of Personal ECG Screening

摘要

As identified by Myerberg et al., efforts to decrease the incidence of out-of-hospital Sudden Cardiac Death (SCD) suffer from an epidemiological paradox.1 The patients at highest annual risk of SCD represent a very small pool of the total population per year who had such an event. In effect, the vast majority of SCD occur in those patients in whom cardiac arrest is the first clinical expression of an underlying disease, or those in whom the disease is previously identified, but classified as low risk. Screening for higher risk features in the general population has not been widely adopted though a variety of relatively inexpensive strategies have been proposed. The surface ECG represents a particularly useful tool given that a variety of easily obtainable measures, such as conduction abnormalities (e.g. QRS duration, heart block), QT prolongation, early repolarization and arrhythmia can all be obtained as indicators of potentially modifiable risk. However, the normal range of many of these measures is wide, requiring frequent within-patient measurements. One particularly promising area is the monitoring of the QT interval after medication change.