智能手表对主动脉瓣置换术后患者心房颤动及左束支传导阻滞的诊断价值

doi:10.3877/cma.j.issn.2095-6568.2023.01.005

目的

探讨智能手表在诊断经导管主动脉瓣置换术（TAVR）后新发心房颤动（房颤）及左束支阻滞（LBBB）的价值。

方法

纳入2020年7月至2021年3月在浙江大学医学院附属第二医院心血管内科接受经股动脉TAVR患者，记录术前、术后12导联体表心电图及智能手表记录的单导联心电图，使用受试者工作特征曲线分析智能手表诊断房颤及LBBB的敏感度及特异度。

结果

共入选202例患者，其中男117例，年龄（73.52±7.69）岁。智能手表诊断TAVR术后房颤与LBBB的敏感度分别为88%与84%。在智能手表记录的380份心电图中，判断房颤出现假阳性4次，假阴性6次；判断LBBB出现假阳性10次，假阴性7次。

结论

智能手表在判断TAVR术后患者房颤及LBBB中的敏感度及特异度均较高，提示智能手表可用于监测TAVR术后房颤与LBBB的发生。

关键词: 心房颤动, 经导管主动脉瓣置换, 智能手表, 左束支传导阻滞

Objective

To explore the value of smart watch in diagnosis of atrial fibrillation (AF) and left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR).

Methods

The patients who underwent trans-femoral TAVR in the Department of Cardiology, The Second Affiliated Hospital Zhejiang University School Of Medicine from July 2020 to March 2021 were included in this study. Electrocardiograms and single-lead electrocardiograms which were recorded by smart watch were analyzed before and after procedure. Receiver operating characteristic (ROC) curve was used to analysis the sensitivity and specificity of a smart watch in the diagnosis of AF and LBBB after TAVR.

Results

A total of 202 patients were enrolled, including 117 male patients with an average age of (73.52±7.69) years. The sensitivity for diagnosing AF and LBBB was 88% and 84% respectively. In a total of 380 electrocardiograms recorded by smart watch, 4 false positives and 6 false negatives were happened in diagnosis of AF, while 10 false positives and 7 false negatives in identifing left bundle branch block.

Conclusion

The sensitivity and specificity of smart watch in diagnosis of AF and LBBB in patients after TAVR are high. It can be considered identifying AF and LBBB after TAVR with smart watch.

Key words: Atrial fibrillation, Transcatheter aortic valve replacement, Smart watch, Left bundle branch block

表1 202例经导管主动脉瓣置换术患者基线特征

项目	数值
男［例（%）］	117（57.92）
年龄（岁， $x ¯ ± s$ ）	73.52±7.69
12导联体表心电图（例）	380
术前	200
心房颤动	26
左束支传导阻滞	5
术后1 d内	180
心房颤动	24
左束支传导阻滞	40
智能手表单导联心电图（例）	380
术前	200
心房颤动	25
左束支传导阻滞	2
术后1 d内	180
心房颤动	23
左束支传导阻滞	46

表1 202例经导管主动脉瓣置换术患者基线特征

项目	数值
男［例（%）］	117（57.92）
年龄（岁， $x ¯ ± s$ ）	73.52±7.69
12导联体表心电图（例）	380
术前	200
心房颤动	26
左束支传导阻滞	5
术后1 d内	180
心房颤动	24
左束支传导阻滞	40
智能手表单导联心电图（例）	380
术前	200
心房颤动	25
左束支传导阻滞	2
术后1 d内	180
心房颤动	23
左束支传导阻滞	46

图1 TAVR术后新发心房颤动及左束支传导阻滞的ROC曲线［1A为智能手表判断患者心房颤动的ROC曲线；1B为智能手表判断患者左束支传导阻滞的ROC曲线］TAVR为经导管主动脉瓣置换术；ROC为受试者工作特征曲线；AUC为曲线下面积

表2 12导联体表心电图与智能手表判断心房颤动与左束支传导阻滞的结果对比

智能手表判断	心房颤动		左束支传导阻滞
智能手表判断	12导联心电图阴性	12导联心电图阳性	12导联心电图阴性	12导联心电图阳性
阴性	326	6	325		7
阳性	4	44	10		38

表2 12导联体表心电图与智能手表判断心房颤动与左束支传导阻滞的结果对比

智能手表判断	心房颤动		左束支传导阻滞
智能手表判断	12导联心电图阴性	12导联心电图阳性	12导联心电图阴性	12导联心电图阳性
阴性	326	6	325		7
阳性	4	44	10		38

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The value of smart watch in diagnosis of atrial fibrillation and left bundle branch block after transcatheter aortic valve replacement

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The value of smart watch in diagnosis of atrial fibrillation and left bundle branch block after transcatheter aortic valve replacement