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CLINICAL EFFECTIVENESS OF HOME ECG MONITORING IN THE
MANAGEMENT OF POST-INFARCTION CARDIAC ARRHYTHMIAS
Hamroyeva Madinabonu Yo‘ldosh kizi
Bukhara State Medical Institute
Assistant at the Department of Faculty and Hospital Therapy
e-mail: madinabonu_hamroyeva@bsmi.uz
xamrayevamadina96@gmail.com
Abstract:
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-MI patients.
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
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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 and Methods
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 Holter electrocardiographic monitoring (ECG).
Based on clinical comparability, patients were divided into two 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
of a district 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. The system was configured in Nebb standard lead configuration.
ECG recordings were transmitted to the cardiology center using protocols recommended at
hospital discharge, based on two 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
indicate arrhythmic events. This mode enabled detection of symptomatic arrhythmias.
Scheduled time-interval mode: ECG was transmitted either at fixed intervals (e.g., every 3 or 6
hours) or adaptively, based on the individual daily physiological patterns of the patient. This
mode facilitated the identification of asymptomatic arrhythmias and silent myocardial ischemia.
The clinical relevance of this approach is supported by evidence of intra-daily rhythmicity in the
course of ischemic heart disease (IHD). Holter monitoring was used to determine patient-specific
rhythms of cardiac disturbances.
Additional indications for ECG auto-transmission included episodes of retrosternal or cardiac-
region chest pain.
Results and Discussion
A total of 12,775 ECG recordings were transmitted to the cardiology center. There were no
statistically significant differences between the two groups in terms of age, type of myocardial
infarction (Q or QS), frequency of recurrent infarction, or development of early post-infarction
angina pectoris (p > 0.05) (Table 1). The results of 24-hour Holter ECG monitoring conducted
prior to hospital discharge are presented in Table 2. Due to the lack of standardized criteria for
quantifying ventricular ectopic beats (VEBs), we classified ≤30 VEBs per hour as “rare” and >30
as “frequent.” The incidence of ventricular rhythm disturbances was similar in both groups,
reaching 70–75% (rare VEBs). The high detection rate of ventricular arrhythmias at discharge
was likely due to the deliberate selection of patients with persistent rhythm disturbances since
admission, which later facilitated a valid comparison between the groups. Additionally, we
examined the distribution of asymptomatic arrhythmic episodes, i.e., those not accompanied by
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subjective symptoms. During Holter monitoring, patients kept diaries noting occurrences of
palpitations, irregular heartbeats, heart pauses, and other symptoms.
A comparison of diary entries with Holter data revealed that asymptomatic arrhythmias were
observed in 15.3% of patients, accounting for 26.8% of all arrhythmic episodes. This was
attributed to the fact that isolated or even multiple VEBs, especially those occurring during late
diastole, often go unnoticed by patients. For instance, one patient experienced three episodes of
atrial fibrillation without any subjective symptoms. This highlights the limitations of symptom-
triggered telemetric ECG transmission in detecting all rhythm disorders. However, some of these
episodes were identified using scheduled ECG transmissions. It is evident that arrhythmia
detection rates depend directly on the number of ECG recordings per patient. In the tele-ECG
group, the average number of ECG transmissions per patient per day was 2.8, 2.1, and 1.2 during
the first, third, and sixth months, respectively. In the control group, the corresponding rates of
ECG examinations at outpatient clinics were only 0.06, 0.04, and 0.01, respectively—over 20
times less than in the tele-ECG group. Naturally, this disparity significantly influenced the
detection rate of rhythm disturbances. Overall, the diagnosis of ventricular arrhythmias was
markedly higher in the tele-ECG group (Table 3). For instance, during the first post-infarction
month, rare and frequent VEBs were detected in 51.3% of patients in the tele-ECG group (88.6%
rare, 14.1% frequent) compared to only 20.5% in the control group (77.6% rare, 28.3% frequent).
Polytopic and paired VEBs were identified in 31.4% and 13.9% of patients, respectively.
Episodes of non-sustained ventricular tachycardia (VT) were observed only in the tele-ECG
group. By the sixth month, the number of patients with ventricular arrhythmias increased further,
with rare VEBs being 3.5 times and paired VEBs 7.8 times more common than in the control
group.
An unexpected finding was the progressive increase in complex arrhythmias (polytopic, paired
VEBs) over time. This may be due to the resumption of regular daily activities, a decrease in
antiarrhythmic therapy intensity, reduced physician oversight, and patients’ changing attitudes
toward their illness—all contributing to fewer clinic visits. The actual effectiveness of home-
based ECG monitoring is best demonstrated by comparing the baseline Holter monitoring data
and the arrhythmia detection rate in the first post-infarction month. As shown in Figure 1, the
percentage of patients with ventricular arrhythmias was 10.8% higher in the tele-ECG group than
during initial Holter monitoring, owing to the continuous and repeated nature of home ECG
recordings, unlike the one-time Holter monitoring. In contrast, the number of patients with
ventricular arrhythmias in the control group was 27.9% lower than with Holter monitoring and
37.3% lower than in the tele-ECG group.
Conclusions
The use of modern computer-based tele-ECG technology, as a form of home ECG monitoring,
significantly enhances the diagnostic capabilities for arrhythmias in post-infarction patients in
outpatient settings. Tele-ECG enables the detection of rhythm disturbances that are often missed
by routine ECGs at clinics and even by single 24-hour Holter recordings. Daily tele-ECG
monitoring is essential for selecting optimal antiarrhythmic therapy regimens, dosage adjustment,
treatment monitoring, and diagnosing adverse drug effects. It plays a key role in reducing the
incidence of sudden cardiac death (SCD) during the early post-infarction period. In the tele-ECG
group, therapeutic regimen adjustments occurred 31.54% more frequently compared to the
control group. By the sixth month, nearly 100% of patients in the tele-ECG group underwent
medication adjustments, something impossible without continuous ECG control. Antiarrhythmic
proarrhythmic effects were also detected in 5.7% of patients, which were subsequently
confirmed in hospital. Given the low cost and high efficiency, the integration of tele-ECG into
routine post-infarction care is both feasible and advisable, as supported by other studies.
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