第一部分

超长时程动态心电图对心律失常的诊断价值

目的： 验证微型贴附式超长时程动态心电记录仪及软件（Smartpatch，恩识医疗科技 上海有限公司)在心律失常诊断方面的临床价值。

方法： 选取2015年1月1日至2015年7月31日到阜外医院就诊，临床表现为晕厥、晕厥前兆、心悸的30例患者，男20例，女10例，年龄48.78±18.41岁。使用24h动态心电图检测（Holter）后，给予Smartpatch记录14d后返院，进行数据回放及分析。

结果： Smartpatch共诊断出26例患者存在心律失常，阳性率为86.7%，Holter共诊断出4例患者存在心律失常，阳性率13.3%，P<0.05。

结论： Smartpatch及软件用于诊断心律失常安全、高效，诊断心律失常的阳性率明显高于常规Holter检查。

第二部分

超长时程动态心电图检测RR间期的作用分析

目的：验证微型贴附式超长时程动态心电记录仪（Smartpatch）在RR长间期诊断方面的临床价值。

方法：选取2015年1月1日至2016年1月31日到我院就诊，临床表现为晕厥、头晕、黑矇、心悸，符合入选条件的93例患者，男性52例（占55.9％），女性41例，年龄53.3±17.3岁。使用Smartpatch记录14d后返院，平均佩戴时间为14.25 2.89d，有效记录时间为12.23 3.84d。进行数据回放及分析。1.选取RR间期 2s的患者分别从时间、年龄、性别、心律失常类型、长RR间期的严重程度、心率变异性等方面进行进一步分析。2.选取RR间期 2s的患者，并对其每日发作长RR间期的时间点(每小时记录一次)进行记录，选取每日均在同一时间点发作长RR间期的患者进行分析，分别从年龄、性别、心律失常类型、长RR间期的严重程度、长RR间期重复的时间点、心率变异性等方面进行进一步分析。

结果：Smartpatch共诊断出28例患者存在 2s RR长间期，检出率为30.1％。其中男性17例（占61.7％），平均年龄55.8 ，平均佩戴时间为14.12 d，有效记录时间为10.33 3.56d，共检出窦性停搏16例，房颤或房扑中RR长间期8例，二度房室传导阻滞4例。最长RR长间期为4257ms。长RR间期具有明显的昼夜节律，夜间发作最频繁，夜间长RR间期每小时发作例数达40%以上，夜间长RR间期每小时发作阵次达10%以上。夜间（24点-5点）时间段发作长RR间期例数及阵次均为最多，发作例数占89.3%，发作阵次比例占71.4%，且与下午（12点-17点）时间段对比，均有统计学差异，再将24小时分成日间12h及夜间12h，仍可见夜间发作最多，发病例数占82.1%，与日间比均有统计学差异。从长间歇严重程度分析，长RR间期以2-3S长间歇最为常见，发作例数占96.4%，发作阵次占99.8%，均有统计学差异。

将佩戴Smartpatch的患者分为长RR间期组（28人）和正常对照组（65人），对HRV相关的时域指标及频域指标进行分析。从时域指标来看，Smartpatch分析所得数据指标均高于正常参考范围及对照组，且NN间期（长RR间期组951.25±192.28ms）、SDNN（长RR间期组162.93±63.49ms）、RMSSD（长RR间期组82.54±71.25ms）、PNN50（长RR间期组17.54±11.08%）与对照组NN间期（对照组859.53±108.25ms）、SDNN（对照组132.71±39.67ms）、RMSSD（对照组44.55±35.17ms）、PNN50（对照组11.37±10.24%）比较，且有统计学差异。在频域指标的对比中，TP、VLF、LF、HF与对照组比较均高于对照组，HF在长RR间期组（352.64±521.05 ms²）与对照组（212.66±291.3 ms²）的比较中具有统计学差异。考虑长RR间期的时间分布与自主神经调控相关。

结论： Smartpatch用于长RR间期的诊断中安全、有效，不仅能弥补24小时动态心电监测（Holter）时间窗短、易漏诊的不足，更能通过记录每日心律失常发作时间而发现心律失常的发作规律，为调整心律失常的治疗提供临床依据。

PART I

·         clinical application study  of very long-term ECG monitoring for arrhythmia

Objective: To investigate the application of long-attached ambulatory electrocardiographic recorder and software (Smartpatch) for arrhythmia diagnosis．

Methods: From January 2015 to July 2015，30 cases of arrhythmia patients (aged 48.78±18.41years，10 female）treated in our hospital were enrolled．Each patient had the Smartpatch monitoring for 14 days after routine 24h Holter monitoring．The arrhythmia detection rates were compared and the types of arrhythmia were analyzed．

Results: Four cases were detected arrhythmia and the arrhythmia detection rate of Holter was 13.3%；Twenty-six cases were detected arrhythmia and the detection rate of smartpatch was 86.7% (P<0.05) ．

Conclusion: It is more convenient，effective to practice smartpatch in arrhythmia detection compared with routing Holter recording．

PART II

Application of Very Longterm electrocardiographic monitoring in Detecting the Long RR Interval.

Objective:To investigate the clinical value of long-attached ambulatory electrocardiographic recorder and software (Smartpatch) in RR long interval diagnosis.

Method: Select 93 patients who came to our hospital from Jan. 1^st 2015 to Jan. 31^st 2016 with clinical manifestations of syncope, dizziness, amaurosis and palpitation, in which there are 52 male patients (accounts for 55.9%) and 41 female patients at ages of 53.3±17.3years. Each patient had the Smartpatch monitoring for 14 days make data play back and analysis.1. Choose patients with RR intervals  2s and make further analysis from time, age, gender, arrhythmia, seriousness degree of long RR interval, heart rate variability and other aspects.2. Patients with RR interval 2s were selected out. And the time points of daily long RR interval were recorded (every hour) and the patients with the long RR interval at the same time were selected out for analysis. Further analysis was conducted on age, gender, type of arrhythmia, serious degree of long RR interval, time point of long RR interval repeatability, heart rate variability, etc

Result: Smartpatch diagnosed that there are 28 patients with 2s RR long interval and detection rate is 30.1%, in which there are 17 males (accounts for 61.7%), average age at 55.8 17.9years, average wearing time at 14.12 3.13d, effective recording time at 10.33 3.56d, 16 cases of sinus arrest have been detected, 8 cases of atrial fibrillation or RR long interval in atrial flutter have been detected, 4 cases of second degree atrioventricular block. Longest RR long interval is 4257ms. Long RR interval has obvious circadian rhythm, which attacks most frequently at night. The attack cases per hour of long RR interval at night reached over 40% and the frequency per hour of long RR interval at night reached over 10%. The cases and frequency of long RR interval at night (24-5) were the most, the cases occupying 89.3% and the frequency proportion occupying 71.4%; comparing with the afternoon (12-7) period, the difference had statistical significance. When 24 hours were further divided into day 12h and night 12h, the attacks at night were still the most, the attack cases occupying 82.1%; comparing with that in the daytime, it had statistical difference. From the serious degree of long cause, 2~3S intervals at long RR period were the commonest, the attack cases occupying 96.4%, the attack frequency occupying 99.8%, they all had statistical difference.

Patients wearing Smartpatch were divided into long RR interval group (28 cases) and normal control group (65 cases) and analysis was conducted on HRV related time-domain indexes and frequency-domain indexes. From the time-domain indexes, the data obtained from Smartpatch analysis were all higher than that of the normal reference range and the control group and comparing NN interval (long RR interval group 951.25±192.28ms), SDNN (long RR interval group 162.93±63.49ms), RMSSD (long RR interval group 82.54±71.25ms), PNN50 (long RR interval group 17.54±11.08%) with NN interval (control group 859.53±108.25ms), SDNN (control group 132.71±39.67ms), RMSSD (control group 44.55±35.17ms), PNN50 (control group 11.37±10.24%) of the control group, it had statistical difference. Comparing the frequency-domain indexes, TP, VLF, LF, HF were all higher than that of the control group. The comparison of HF between long RR interval group (352.64±521.05 ms2) and the control group (212.66±291.3 ms2) had statistical difference. It is thought that the time distribution of long RR interval group was related to autonomic nervous regulation.

Conclusion: It is safe and efficient to use Smartpatch in the long RR interval diagnosis. It can not only make up for the insufficiencies of Holter such as short monitoring window time, missed diagnosis, etc., but can also record the onset rule of arrhythmia by recording the onset time of arrhythmia, so as to provide clinical evidence for the treatment of arrhythmia.