kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2018-7-4S-94-100kpccz-512Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОРANALYTICAL REVIEWПролонгированный ЭКГ-мониторинг. Значение в первичной и вторичной профилактике тромбоэмболических событий при фибрилляции предсердийLong-term ECG monitoring. Significance for primary and secondary prevention of thromboembolic events in atrial fibrillationЧичковаТ. Ю.ChichkovaT. Y.

Чичкова Татьяна Юрьевна - научный сотрудник лаборатории нарушения ритма сердца и электрокардиостимуляции.

650002, Кемерово, Сосновый бульвар, 6

Chichkova Tatyana Yu. - researcher at the Laboratory of Cardiac Arrhythmia and Pacing.

6, Sosnoviy Blvd., Kemerovo, 650002

chi4cova@ya.ruМамчурС. Е.MamchurI. E.

Мамчур Сергей Евгеньевич - доктор медицинских наук, заведующий отделом диагностики сердечно-сосудистых заболеваний, заведующий лабораторией нарушения ритма сердца и электрокардиостимуляции.

Сосновый бульвар, 6, Кемерово, 650002

Mamchur Sergei E. - PhD, Head of the Department of Cardiovascular Diseases Diagnosis, Head of the Laboratory of Cardiac Arrhythmia and Pacing.

6, Sosnoviy Blvd., Kemerovo, 650002

ХоменкоЕ. А.KhomenkoE. A.

Хоменко Егор Александрович - кандидат медицинских наук, научный сотрудник лаборатории нарушения ритма сердца и электрокардиостимуляции НИИКПССЗ, врач-сердечно-сосудистый хирург кабинета рентгенохирургических методов диагностики и лечения КОККД им. академика Л.С. Барбараша.

Сосновый бульвар, 6, Кемерово, 650002

Khomenko Yegor A. - PhD, researcher at the Laboratory of Cardiac Arrhythmia and Pacing, RICCD; interventional cardiologist at the SBHIKRCCD n.a. Academician L.S. Barbarash.

6, Sosnoviy Blvd., Kemerovo, 650002

ПоликутинаО. М.PolikutinaO. M.

Поликутина Ольга Михайловна - доктор медицинских наук, заведующая лабораторией ультразвуковых и электрофизиологических методов.

Сосновый бульвар, 6, Кемерово, 650002

Polikutina Olga M. - MD, PhD, Head of the Laboratory of Ultrasound and Electrophysiological Methods.

6, Sosnoviy Blvd., Kemerovo, 650002

Федеральное государственное бюджетное научное учреждение Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеванийРоссияFederal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular DiseasesRussian FederationФедеральное государственное бюджетное научное учреждение Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний; Государственное бюджетное учреждение здравоохранения Кемеровской области Кемеровский областной клинический кардиологический диспансер имени академика Л.С. БарбарашаРоссияFederal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases; State Budgetary Healthcare Institution of the Kemerovo Region Kemerovo Regional Clinical Cardiology Dispensary n.a. Academician L.S. BarbarashRussian Federation20180202201974S94100Copyright © Чичкова Т.Ю., Мамчур С.Е., Хоменко Е.А., Поликутина О.М., 20202020Чичкова Т.Ю., Мамчур С.Е., Хоменко Е.А., Поликутина О.М.Chichkova T.Y., Mamchur I.E., Khomenko E.A., Polikutina O.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/512

В настоящем обзоре представлены современные данные по применению пролонгированного ЭКГ-мониторинга для ведения пациентов с фибрилляцией предсердий (ФП). Пролонгированный ЭКГ мониторинг позволяет получить большой объем диагностической информации и оптимизировать ведение пациентов с асимптомным течением ФП путем своевременного назначения антикоагулянтной терапии. Это имеет принципиальное значение в профилактике тромбоэмболических осложнений.

The review presents current data on the use of the long-term ECG monitoring for the management of patients with atrial fibrillation (AF). Long-term ECG monitoring allows receiving large amounts of diagnostic data and optimizes clinical management by the timely start of anticoagulant therapy in the patients with silent AF. This is a crucial issue for prevention of thromboembolic events.

фибрилляция предсердийимплантируемый петлевой регистратор экгинсультatrial fibrillationimplantable loop recorderstrokeReferencesHart RG, Pearce LA, Aguilar MI. Meta-analysis; antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146: 857-867Hart RG, Pearce LA, Aguilar MI. Meta-analysis; antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146: 857-867Hindricks G., Piorkowski C., Tanner H., Kobza R., GerdsLi J.H., Carbucicchio C., Kottkamp H. Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation. 2005; 112(3): 307-313Hindricks G., Piorkowski C., Tanner H., Kobza R., GerdsLi J.H., Carbucicchio C., Kottkamp H. Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation. 2005; 112(3): 307-313Verma A., Champagne J., Sapp J., Essebag V., Novak P., Skanes A., Morillo C.A., Khaykin Y., Birnie D. Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study. JAMA Intern Med. 2013; Vol. 173(2): 149-156. doi: 10.1001/jamainternmed.2013.1561.Verma A., Champagne J., Sapp J., Essebag V., Novak P., Skanes A., Morillo C.A., Khaykin Y., Birnie D. Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study. JAMA Intern Med. 2013; Vol. 173(2): 149-156. doi: 10.1001/jamainternmed.2013.1561.2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Available at: http://www.heartrhythmjournal.com/article/S1547-5271(17)30590-8/fulltext. (accessed 06.12.2018).2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Available at: http://www.heartrhythmjournal.com/article/S1547-5271(17)30590-8/fulltext. (accessed 06.12.2018).Passman R., Leong-Sit P., Andrei A.C., Huskin A., Tomson T.T., Bernstein R. et al. Targeted anticoagulation for atrial fibrillation guided by continuous rhythm assessment with an insertable cardiac monitor: The Rhythm Evaluation for Anticoagulation With Continuous Monitoring (REACT.COM) pilot study. J Cardiovasc Electrophysiol. 2016; 27: 264-270. doi: 10.1111/jce.12864Passman R., Leong-Sit P., Andrei A.C., Huskin A., Tomson T.T., Bernstein R. et al. Targeted anticoagulation for atrial fibrillation guided by continuous rhythm assessment with an insertable cardiac monitor: The Rhythm Evaluation for Anticoagulation With Continuous Monitoring (REACT.COM) pilot study. J Cardiovasc Electrophysiol. 2016; 27: 264-270. doi: 10.1111/jce.12864Zuern C.S., Killias A., Berlitz P., Seizer P., Gramlich M., Muller K. et. al. Anticoagulation after catheter ablation of atrial fibrillation guided by implantable cardiac monitors. PACE. 2015; 38: 688-693. doi: 10.1111/pace.12625.Zuern C.S., Killias A., Berlitz P., Seizer P., Gramlich M., Muller K. et. al. Anticoagulation after catheter ablation of atrial fibrillation guided by implantable cardiac monitors. PACE. 2015; 38: 688-693. doi: 10.1111/pace.12625.Lin H.J., Wolf P.A., Kelly-Hayes M., Beiser A.S., Kase C.S., Benjamin E.J., D'Agostino R.B. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760-1764Lin H.J., Wolf P.A., Kelly-Hayes M., Beiser A.S., Kase C.S., Benjamin E.J., D'Agostino R.B. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760-1764Feng W., Hendry R.M., Adams R.J. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology. 2010; 74(7): 588-593. doi: 10.1212/WNL.0b013e3181cff776.Feng W., Hendry R.M., Adams R.J. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology. 2010; 74(7): 588-593. doi: 10.1212/WNL.0b013e3181cff776.Ziegler P.D., Koehler J.L., Mehra R. Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm. 2006; 3(12): 1445-1452.Ziegler P.D., Koehler J.L., Mehra R. Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm. 2006; 3(12): 1445-1452.Евтушенко В.В., Поликутина О.М., Мамчур С.Е., Чичкова Т.Ю., Романова М.П. Методы длительного амбулаторного мониторирования электрокардиограммы: Обзор. Комплексные проблемы сердечно-сосудистых заболеваний; 2017; 6 (4): 133137. doi: https://doi.org/10.17802/2306-1278-2017-6-4-133-137Evtushenko V.V., Polikutina O.M., Mamchur S.E., Chichkova T.Y., Romanova M.P. Methods for long-term ecg monitoring in the outpatient settings: a review. Complex Issues of Cardiovascular Diseases. 2017;6(4):133-137. doi: https://doi.org/10.17802/2306-1278-2017-6-4-133-137 (In Russian)Ziegler P.D., Glotzer T.V., Daoud E.G., Wyse D.G., Singer D.E., Ezekowitz M.D., Koehler JL, Hilker CE.Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events. Stroke; 2010; 41(2): 256-60. doi: 10.1161/STROKEAHA.109.571455.Ziegler P.D., Glotzer T.V., Daoud E.G., Wyse D.G., Singer D.E., Ezekowitz M.D., Koehler JL, Hilker CE.Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events. Stroke; 2010; 41(2): 256-60. doi: 10.1161/STROKEAHA.109.571455.Healey J.S., Connolly S.J., Gold M.R., Israel C.W., VanGelder I.C., Capucci A. et al. ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med; 2012; 366 (2):120-129. doi: 10.1056/NEJMoa1105575.Healey J.S., Connolly S.J., Gold M.R., Israel C.W., VanGelder I.C., Capucci A. et al. ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med; 2012; 366 (2):120-129. doi: 10.1056/NEJMoa1105575.Perera K.S., Sharma M., Connolly S.J., Wang J., Gold M.R., Hohnloser S.H. et al. Stroke type and severity in patients with subclinical atrial fibrillation: An analysis from the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT). Am Heart J. 2018 Jul;201:160-163. doi: 10.1016/j.ahj.2018.03.027.Perera K.S., Sharma M., Connolly S.J., Wang J., Gold M.R., Hohnloser S.H. et al. Stroke type and severity in patients with subclinical atrial fibrillation: An analysis from the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT). Am Heart J. 2018 Jul;201:160-163. doi: 10.1016/j.ahj.2018.03.027.Van Gelder I.C., Healey J.S., Crijns H.J.G.M., Wang J., Hohnloser S.H., Gold M.R. et al. Duration of devicedetected subclinical atrial fibrillation and occurrence of stroke in ASSERT. Eur Heart J; (2017); 38 (17): 1339-1344. doi: 10.1093/eurheartj/ehx042.Van Gelder I.C., Healey J.S., Crijns H.J.G.M., Wang J., Hohnloser S.H., Gold M.R. et al. Duration of devicedetected subclinical atrial fibrillation and occurrence of stroke in ASSERT. Eur Heart J; (2017); 38 (17): 1339-1344. doi: 10.1093/eurheartj/ehx042.Glotzer T.V., Daoud E.G., Wyse D.G., Singer D.E., Ezekowitz M.D., Hilker C., Miller C., Qi. D., Ziegler P.D. The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circ Arrhythm Electrophysiol; 2009;2: 474-480. doi: 10.1161/CIRCEP.109.849638.Glotzer T.V., Daoud E.G., Wyse D.G., Singer D.E., Ezekowitz M.D., Hilker C., Miller C., Qi. D., Ziegler P.D. The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circ Arrhythm Electrophysiol; 2009;2: 474-480. doi: 10.1161/CIRCEP.109.849638.Sanna T., Diener H.C., Passman R.S., Di Lazzaro V., Bernstein R.A., Morillo C.A. et al. Cryptogenic Stroke and Underlying Atrial Fibrillation. N Engl J Med 2014; 370:24782486. DOI: 10.1056/NEJMoa1313600Sanna T., Diener H.C., Passman R.S., Di Lazzaro V., Bernstein R.A., Morillo C.A. et al. Cryptogenic Stroke and Underlying Atrial Fibrillation. N Engl J Med 2014; 370:24782486. DOI: 10.1056/NEJMoa1313600Sacco R.L., Prabhakaran S., Thompson J.L., Murphy A., Sciacca R.R., Levin B., Mohr J.P. Comparison of warfarin versus aspirin for the prevention of recurrent stroke or death: subgroup analyses from the Warfarin-Aspirin Recurrent Stroke Study. Cerebrovasc Dis; 2006;22(1):4-12. DOI: 10.1159/000092331Sacco R.L., Prabhakaran S., Thompson J.L., Murphy A., Sciacca R.R., Levin B., Mohr J.P. Comparison of warfarin versus aspirin for the prevention of recurrent stroke or death: subgroup analyses from the Warfarin-Aspirin Recurrent Stroke Study. Cerebrovasc Dis; 2006;22(1):4-12. DOI: 10.1159/000092331Hart R.G., Sharma M., Mundl H., Kasner S.E., Bangdiwala S.I., Berkowitz S.D. et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med; 2018; 7;378(23):2191-2201. DOI: 10.1056/NEJMoa1802686Hart R.G., Sharma M., Mundl H., Kasner S.E., Bangdiwala S.I., Berkowitz S.D. et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med; 2018; 7;378(23):2191-2201. DOI: 10.1056/NEJMoa1802686Diener H.C., Easton J.D., Granger C.B., Cronin L., Duffy C., Cotton D., Brueckmann M., Sacco R.L. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS). Int J Stroke; 2015;10(8):1309-12. doi: 10.1111/ijs.12630.Diener H.C., Easton J.D., Granger C.B., Cronin L., Duffy C., Cotton D., Brueckmann M., Sacco R.L. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS). Int J Stroke; 2015;10(8):1309-12. doi: 10.1111/ijs.12630.Apixaban for Treatment of Embolic Stroke of Undetermined Source (ATTICUS). Available at: https:// clinicaltrials.gov/ct2/show/NCT02427126?term=ATTICUS&r ank=1. (accessed 04.11.2018)Apixaban for Treatment of Embolic Stroke of Undetermined Source (ATTICUS). Available at: https://clinicaltrials.gov/ct2/show/NCT02427126?term=ATTICUS&r ank=1. (accessed 04.11.2018)Verma N., Ziegler P.D., Liu S., Passman R.S. Incidence of atrial fibrillation among patients with an embolic stroke of undetermined source: Insights from insertable cardiac monitors. Int J Stroke. 2018 Sep 10:1747493018798554. doi: 10.1177/1747493018798554Verma N., Ziegler P.D., Liu S., Passman R.S. Incidence of atrial fibrillation among patients with an embolic stroke of undetermined source: Insights from insertable cardiac monitors. Int J Stroke. 2018 Sep 10:1747493018798554. doi: 10.1177/1747493018798554Kamel H., Okin P.M., Elkind M.S., Iadecola C. Atrial Fibrillation and Mechanisms of Stroke. Time for a New Model. Stroke. 2016 Mar;47(3):895-900. doi: 10.1161/STROKEAHA.115.012004.Kamel H., Okin P.M., Elkind M.S., Iadecola C. Atrial Fibrillation and Mechanisms of Stroke. Time for a New Model. Stroke. 2016 Mar;47(3):895-900. doi: 10.1161/STROKEAHA.115.012004.Hindricks G., Pokushalov E., Urban L., Taborsky M., Kuck K.H., Lebedev D. Performance of a New Leadless Implantable Cardiac Monitor in Detecting and Quantifying Atrial Fibrillation Results of the XPECT Trial. Circ Arrhythm Electrophysiol. 2010 Apr;3(2):141-7. doi: 10.1161/CIRCEP.109.877852.Hindricks G., Pokushalov E., Urban L., Taborsky M., Kuck K.H., Lebedev D. Performance of a New Leadless Implantable Cardiac Monitor in Detecting and Quantifying Atrial Fibrillation Results of the XPECT Trial. Circ Arrhythm Electrophysiol. 2010 Apr;3(2):141-7. doi: 10.1161/CIRCEP.109.877852.Имплантируемый монитор: руководство врача. Medtronic. Режим доступа: http://manuals.medtronic.com/content/dam/emanuals/crdm/CONTRIB_222015.pdf (Дата обращения 04.11.2018)Implantiruemyj monitor: rukovodstvo vracha. Medtronic. Available at: http://manuals.medtronic.com/content/dam/emanuals/ crdm/CONTRIB_222015.pdf (accessed 04.11.2018)Lee R., Mittal S.. Utility and limitations of longterm monitoring of atrial fibrillation using an implantable loop recorder. Heart Rhythm; 15(2): 287-295. doi: 10.1016/j.hrthm.2017.09.009.Lee R., Mittal S.. Utility and limitations of long-term monitoring of atrial fibrillation using an implantable loop recorder. Heart Rhythm; 15(2): 287-295. doi: 10.1016/j.hrthm.2017.09.009.Podd S.J., Sugihara C., Furniss S.S., Sulke N. Are implantable cardiac monitors the “gold standard” for atrial fibrillation detection? A prospective randomized trial comparing atrial fibrillation monitoring using implantable cardiac monitors and DDDRP permanent pacemakers in post fibrillation ablation patients. Europace; 2016; 18: 1000-1005. doi: 10.1093/europace/euv367.Podd S.J., Sugihara C., Furniss S.S., Sulke N. Are implantable cardiac monitors the “gold standard” for atrial fibrillation detection? A prospective randomized trial comparing atrial fibrillation monitoring using implantable cardiac monitors and DDDRP permanent pacemakers in post fibrillation ablation patients. Europace; 2016; 18: 1000-1005. doi: 10.1093/europace/euv367.

The authors declare that there are no conflicts of interest present.