RESUMO
BACKGROUND: Ambulatory electrocardiogram (AECG) is done for evaluation of arrhythmia. Commonly used AECG system is 24 h Holter. Patch based second generation AECG monitoring devices, which can record for longer periods, are now available. OBJECTIVE: Android App based WebCardio using WiPatch is a new AECG system which records ECG in two leads for 72 h. Our study compared the arrhythmia detection by WebCardio and conventional Holter by simultaneously connecting both for 24 h in patients having indication for AECG. METHODS: The AECG of patients who had simultaneous recording with WebCardio and conventional Holter, in the department of Cardiology, Medical College, Thrissur were evaluated. Ability to detect any of the 6 arrhythmias :1) atrial fibrillation (AF), 2) atrioventricular (AV) block, 3) sinus pause of ≥3 s (SP), 4) supraventricular tachycardia (SVT), 5) premature ventricular complex (PVC) and 6) ventricular tachycardia (VT)/ventricular fibrillation (VF) was compared. Detection of each arrhythmia was also compared. RESULTS: 141 patients had simultaneous recordings by both systems of AECG. The WebCardio picked up at least one of the 6 arrhythmias; AF, AV block, SP, SVT, PVC or VT/VF in 98 cases compared to 88 in the Holter (McNemars test, two tail P = 0.006). In eleven cases WebCardio detected an arrhythmia where Holter could not. In one case Holter identified an arrhythmia and WebCardio could not. Individual arrhythmias; AF, SP, SVT and VT/VF were detected equally by both systems. AV block (23 Vs 18, p = 0.0625) and PVCs (83 Vs 74, p = 0.0636) were detected in more number of cases in WebCardio. In the five cases where WebCardio alone identified AV block, four had poor quality of P wave in the Holter. CONCLUSION: Arrhythmia was picked up in more number of patients by the WebCardio compared to Holter. This was due to higher pickup of AV block and PVCs by WebCardio. Difference in AV block identification was due to better quality of P in WebCardio. WebCardio is a good alternative to Holter for AECG.
RESUMO
BACKGROUND: Population access to timely reperfusion is a decisive factor in determining the success and acceptability of any regional system of ST-segment elevation myocardial infarction (STEMI) care. We sought to determine the proportion of population of the southern Indian state of Kerala having timely access to STEMI reperfusion. METHODS: We identified the STEMI reperfusion facilities available at all acute-care hospitals, in Kerala, by conducting a cross-sectional survey. We mapped the geographical catchment areas of these hospitals using historical travel speeds and appropriate Geospatial Information Systems (GIS) analyses. Subsequently, using block level population data, we estimated the proportion of the population residing within these geographies. RESULTS: We estimated that 23.33 million people, forming 69.84% of the state population, resided in the green zone (within half-hour travel distance of a percutaneous coronary intervention [PCI]-capable hospital), which covered 47.94% of the geographical area of the state. Outside this green zone, 21.87% of the state population resided within 1hr travel distance of a thrombolysis-capable hospital. Finally, 8.28% of the state population resided in the red zone, where access to any reperfusion-capable hospital took >1hr, which covered 22.15% of the geographical area of the state. CONCLUSIONS: A majority of the population of Kerala had timely access to PCI-capable hospitals. GIS-based mapping of Indian states, in terms of access to STEMI reperfusion, may help devise protocols to achieve seamless transfer of patients to reperfusion-capable hospitals. Such regionalization of STEMI care would enhance organizational synergies to achieve better access to reperfusion, especially in remote areas.