CLINICAL EFFECTIVENESS OF HOME ECG MONITORING IN THE MANAGEMENT OF POST-INFARCTION CARDIAC ARRHYTHMIAS

Аннотация

This study evaluates the clinical effectiveness of ambulatory telemetric electrocardiographic (AT ECG) monitoring in patients during the early post-myocardial infarction (MI) period. A total of 136 patients with Q-wave MI were divided into two comparable groups: 70 patients in the main group used AT ECG monitoring for 6 months, while 66 patients in the control group underwent standard follow-up by district cardiologists. All patients received comparable anti-ischemic and antiarrhythmic therapy. The frequency of ventricular arrhythmia detection was significantly higher in the AT ECG group due to more frequent and timely ECG recordings. The study demonstrated that the use of symptom-triggered and time-triggered ECG transmission modes allowed for the identification of both symptomatic and asymptomatic arrhythmias. Additionally, the dynamic ECG monitoring facilitated more frequent adjustments of pharmacological therapy, improving its individual optimization and safety. The results show that home-based AT ECG monitoring not only increases the detection rate of ventricular arrhythmias but also contributes to better therapeutic control and may reduce sudden cardiac death in post-MIpatients. Keywords: Post-infarction monitoring, ventricular arrhythmia, ambulatory ECG, telemetric ECG, sudden cardiac death, myocardial infarction, home-based diagnostics, Holter monitoring comparison Life prognosis in post-myocardial infarction (MI) patients remains a challenging clinical issue due to the multifactorial nature of its determinants. One of the key prognostic factors is cardiac rhythm disturbances (CRDs). Research has demonstrated that among MI survivors, the presence of rare monomorphic premature ventricular contractions (PVCs) increases the risk of mortality fivefold, salvos tenfold, and early PVCs up to fifteenfold compared to patients without ventricular ectopic activity. Clinical follow-up has shown that patients who exhibited frequent PVCs before hospital discharge were at a significantly higher risk of developing paroxysmal ventricular tachycardia (PVT) and experiencing sudden cardiac death (SCD). In such cases, regular cardiac rhythm monitoring could help in preventing life-threatening complications. However, conventional outpatient care after acute myocardial infarction (AMI) often fails to provide sufficient and timely electrocardiographic (ECG) evaluation, limiting early intervention opportunities. In Russia, telecardiology consulting and diagnostic centers—facilitating remote ECG transmission via telephone—once played a crucial role in early diagnosis of cardiovascular diseases (CVDs), organizing long-term follow-up of cardiac patients, enhancing diagnostic accuracy, and improving emergency care. Nonetheless, they lacked the capacity for individualized dynamic ECG monitoring, especially in high-risk patients vulnerable to recurrent or primary cardiac events. The auto-transmission (AT) method, where the patient independently transmits their ECG via phone to a cardiology center, has emerged as the most efficient form of https://ijmri.de/index.php/jmsi volume 4,issue5,2025 499 home ECG monitoring. This system ensures real-time two-way voice communication between patient and physician, enabling prompt, patient-specific clinical assessment. Objective of the study: To evaluate the effectiveness of home ECG monitoring using the auto-transmission method for early detection and differential diagnosis of cardiac rhythm disturbances and for assessing the efficacy of antiarrhythmic therapy during the outpatient phase of care in post-MI patients. Materials andMethods The study involved 136 patients who were discharged from the clinic of the Research Institute of Cardiology with a diagnosis of Q-wave myocardial infarction (Q-MI). Prior to discharge, all participants underwent 24-hour Holterelectrocardiographic monitoring(ECG). Based on clinical comparability, patients were divided intotwo groups: Group I (intervention group): 70 patients used ECG home monitoring with the auto-transmission (AT)method for six months. Group II (control group): 66 patients received conventional rehabilitation under the supervision ofadistrict cardiologist. Both groups received standardized pharmacological treatment, including nitrates, beta-blockers, aspirin,and angiotensin-converting enzyme inhibitors(ACEIs). For ECG auto-transmission, a three-channel portable ECG transmitter “EKP-302I” (MIKTO- Intech, Saratov) was used. Thesystem was configured in Nebb standard lead configuration. ECG recordings were transmitted to the cardiology center using protocols recommended at hospitaldischarge,based ontwo modes: Symptom-triggered mode: Patients were instructed to transmit ECG data upon experiencing subjective complaints such as palpitations, skipped beats, sudden cardiac pauses, dizziness, blurred vision, near-syncope or syncope, dyspnea, or unexplained fatigue—all of which could indicatearrhythmic events. This modeenabled detection ofsymptomatic arrh