[Home ECG monitoring of high-risk post-myocardial infarction patients]

In the era of acute coronary interventions, patients who suffered myocardial infarction (MI) are discharged early (after just a few days) either home or to a rehabilitation facility. However, mortality rate is the highest during the first month after MI. Most endangered patients are those who lost a significant percentage of their myocardium and have a consequential decreased left ventricular systolic function. Given the advances of telemedicine, it may be therefore important to develop new methods of home arrhythmia monitoring for these patients.

To determine the reliability of internet-based continuous home arrhythmia monitoring during the first month after discharge in patients with decreased left ventricular function who suffered an acute MI and underwent coronary intervention.

Although numerous telephone-based ECG monitoring systems exist, authors present their experiences with a new technology involving continuous, internet-based ECG monitoring which does not require activation by the patient. A mobile internet based device was developed for those patients who did not have internet access.

We monitored 10 post-MI patients who were discharged home with an ejection fraction of less than 40 percent. Cumulative monitoring time was 170 days. The completely noise-free and error-free ECG periods amounted to 98 percent and 99 percent, respectively. Average time to response to the 66 alarms raised was 27 seconds. Average number of alarms per day was 0.39 while positive predictive value of the alarms was 0.106. Total alarm time was 29.8 minutes which works out to 10.5 seconds per day.

The unique chest band we developed makes possible to produce error-free ECG records during most of the monitoring period. Our method appears to be suitable for home monitoring of patients discharged from hospital. Low alarm time means that many patients can be monitored simultaneously without compromising patient safety.