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Atrial fibrillation is the most frequent clinically significant arrhythmia. Its occurrence in adult population was previously reported to be 0.4 %, currently it is more or less 0.95 %. In industrial countries the population of patients with ischemic heart disease is increasing; with progress in therapy of such patients the number of individuals with heart disease has increased. Increasing prevalence of atrial fibrillation, which occurs frequently with such diseases, is also expected. Concurrence with atrial flutter, atrial macroreetnry arrhythmia is relatively frequent. Both arrhythmias may alternate in a patent or change from one to another. Efforts with medication therapies were not sufficiently successful in the past. New products have been sought all the time – the products which would have influence on the atrial muscle and have no influence on ventricular myocardium, have no side effects and no proarrhythmogenic potential. Simultaneously, ways of non-pharmacological treatment have been sought. The non-pharmacological methods are prevailing currently since pharmaceutical products fail and have irregular effect. The category of non-pharmacological treatment includes cardio-stimulating methods and ablation techniques. Accordingly, there were no sufficiently sophisticated methods of evaluating of arrhythmia occurrence after ablation procedures. The development of efficient detection, processing and evaluation of heart activity proceeds to long-term monitoring of heart signals using an implantable heart monitor. The latest model of implantable heart monitor has been introduced in clinical practice; it is particularly intended for diagnostics of atrial arrhythmias. The above-mentioned implant bears trade name REVEALŽ XT, produced by the MEDTRONIC Company. This thesis elaborates comprehensively the issue of implantable heart monitors of the latest generation which are specially intent on diagnostics of atrial arrhythmias. It summarizes data that was collected as a part of two world-wide multicentre studies EPECT and VISIT. In this thesis I analyze data obtained at the centre of acute cardiology hospital Na Homolce. The data population offers a comprehensive view of potentials of subcutaneous heart monitors from the pre-implanting phase to one-year follow-up of detection properties and classifications of heart arrhythmias with a strong emphasis on an analysis of atrial tachyarrhythmias. Based on thus analyzed data the following conclusion can be made: The implantable heart monitor REVEALŽ XT is suitable for clinical applications of long-term monitoring of heart rhythm both in the area of ventricular and atrial arrhythmias.

Dynamics of cardiovascular indices during the 24 hours and exercise training session in aerobics SUMMARY Objects: The aim of this study was to assess the peculiarities in functioning of cardiovascular system during 24 hours and aerobic exercise session. Goals: 1) to monitor the functioning of cardiovascular system during 24 hours. 2) to assess the dynamic of ECG parameters during 24 hours and aerobic exercise. 3) to compare the variability of ECG parameters during 24 hours and aerobic exercise sessions. 4) to assess the distribution of ECG parameters during 24 hours and aerobic exercise. Research contingent: The participants in this study were 29 voluntary students (age of 22,6±0,43) who attended healthiness aerobic exercise club for 2-3 times per week Methods: The computerized system “Cardio Scout” designed for registration and analysis of 5 lead ECG was used for this purpose. The questionnaire for all participants was presented. Results: The values of JT interval and ST-segment depression during the highest intensity phase of exercise session increased significantly and was different in mobilization and recovery phases (p<0.05). We found-out that values of hart rate (HR) was the lowest and JT intervals was the longer during 24 hours monitoring (p<0.0001). During the exercise HR was higher than during the all time of 24 hours monitoring. The amplitude of R wave of ECG during 24 hours was completely the same and ST-segment depression was similar (p>0.05). Statistically... [to full text]

隨著少子化、老年化的時代來臨，以「銀髮族」為目標客戶的產業前景看好。全世界已開發國家人口老化日趨嚴重，社會醫療成為各國財政越來越沈重的包袱，於是以提升高齡者自立能力、降低醫療負擔，提高生活品質為目的的「遠距照護產業」備受重視。相較於其它先進國家，我國遠距照護產業發展較晚。衛生署主導的「遠距照護試辦計畫」第一階試辦已完成，目前進入第二階段擴大推廣。因而，本論文探討的核心問題，在於如何建立成功的遠距照護產業營運模式。 本論文選擇遠距照護應用中的「遠距心電圖監測」作為研究標的，乃因心電圖監測技術已有成熟發展，且全世界心臟病人口日益增加，值得投資。本論文修改技術與市場二分法的研究模式，除了「產業環境」與「營運模式分析」，更將「專利」與「查驗登記制度」納入研究環節。技術、專利與查驗登記制度雖非傳統營運模式分析的重要核心，但對於發展此產品、服務，有一定的影響。由於美國遠距心電圖產監測業發展較我國成熟，本論文比較美國與台灣發展現況，並選擇兩家於美國提供遠距心電圖監測服務的LifeWatch AG與CardioNet, Inc.作為個案研究的對象。 研究結果發現，遠距心電圖監測服務在美國主要用於輔助醫師診斷心臟疾病。不受限於環境，長期連續不間斷監測心電圖的特性，使其市場表現快速成長。美國成功建構產業的關鍵在於完善的商業機制。此外，亦發現美國針對六十五歲以上高齡人口的政府保險Medicare，其給付金額對市場發產有舉足輕重的影響，值得我國政府借鏡。建議台灣應該在保護民眾生命財產安全，以及發展產業之間取得平衡，建構一個適合發展創新技術、創新服務的產業環境。 此外，研究結果發現，台灣尚未能成功發展遠距心電圖監測服務的關鍵，並非技術，而是商業模式。台灣以保守的醫院為服務窗口的營運策略，是衛生署比擬全民健保機制，推動年長者長期健康照護制度的產物，屬於社會福利的性質，與發展產業的概念背道而馳，而且成本過高。另一方面，民眾沒有長期測量生理參數的習慣，拓展市場不易，此二者為台灣長期推動服務失敗的主要原因。因此，本研究最後建議，應捨棄以醫院為中心的服務模式，設計一套能夠被民眾廣為接受的營運模式，提供彈性的價格與服務，搭配適當的宣傳，方能突破現狀。 / Population aging is getting more and more serious among developed countries, as well as the extremely heavy medical treatment budgets. Consequently, governments start to think about how to make medical service more efficient by means of information technology; businessmen start to provide telemedicine service, in order to let the elder live more independently and healthier. A pilot remote health care project, held by the Department of Health, is moving to the second stage this year. Many telemedicine service centers had been built in the hospitals at the first stage, and now government is seeking for more hospitals and companies setting up more service centers in Taiwan. This is time to check weather it is a good business model worthy of working on, or there is a better way to develop telemedicine business. Remote ECG monitoring is one of the typical telemedicine services. Many people are suffering from cardiac disease in developed countries, and there are already some successful business models in the U.S. This is the reason why this studies focuses on remote ECG monitoring. This study takes into account technology, patent, FDA regulations, markets, and industrial environment aspects. Usually, only markets and industrial environment would be taken into account in this kinds of theses. Technology, patents, and FDA regulations, however, may have significant impact on business. The purpose of this essay is to advice to Taiwan, by comparing the difference between the U.S. model and Taiwan model, and analyzing two cases, LifeWatch AG and CardioNet, Inc.. According to the above surveys, remote ECG monitoring is mostly used for diagnosis. The key factor is the well-built U.S. medical system. The U.S. governmental health insurance, the Medicare, has huge influence on remote the ECG monitoring industry. The medical treatment system is open and well-governed, and suits for incubating new products. Although the medical system is relatively conservative in Taiwan, it is recommended that the Taiwan government should create some mechanisms that will encourage innovative telemedicine services. There are two reasons that make remote ECG monitoring services in Taiwan is not as successful as those in the U.S. Firstly, the services are provided by hospitals. Hospitals are conservative, and services doctors are expensive. So, there are less innovative business models, and the costs rocket high. Monitoring centers should be set outside the hospitals. Secondly, patients don’t “feel” the benefit from monitoring ECG constantly, so usually they quit the services in the second month. Therefore, marketing and promotion should be taking place. Services and prices should be more flexible and cost-effective as well. At this moment, the biggest challenge of remote ECG monitoring is business model, not technology, FDA regulations, or even patents

La fibrillation atriale (FA) est une complication fréquente de la phase aiguë de l’infarctus (IDM) avec un moins bon pronostic des patients. Sa forme silencieuse pourrait être fréquente après un IDM. Cependant, toutes les études ayant porté sur la FA se sont focalisées sur les formes symptomatique, paroxystique ou persistante. De plus, la réduction de la biodisponibilité du •NO et la dysfonction endothéliale peuvent altérer le pronostic des patients en FA. Or, l’asymétrique diméthylarginine (ADMA) en inhibant de façon endogène l’action des NO synthases peut conduire à une dysfonction endothéliale, une inflammation ou encore à un stress oxydatif, qui sont impliqués dans de nombreuses pathologies cardiovasculaires. Cependant, au-cune étude n’a évalué la relation potentielle entre le taux plasmatique d’ADMA et la survenue d’une FA après un IDM.Notre objectif a été d’évaluer dans le cadre d’une étude prospective le pronos-tic hospitalier et à un an des patients présentant de la FA silencieuse en phase ai-guë d’IDM, et évaluer le lien potentiel entre les dimethylarginines et l’apparition d’une FA. Notre première étude prospective montre pour la première fois que la FA si-lencieuse est plus fréquente que la FA symptomatique et est associée à un moins bon pronostic après un IDM.Notre second travail, démontre que l’impact négatif de la FA silencieuse sur le pronostic des patients se maintient à un an après l’IDM.Notre troisième travail montre également, que l’ADMA est associée de ma-nière indépendante à la survenue d’une FA symptomatique après un IDM. Ces données suggèrent qu’un dépistage et qu’une prise en charge spécifiques de la FA après un IDM pourraient améliorer le pronostic des patients. L’ADMA pourrait ainsi être utilisée comme un marqueur de risque de passage en FA après un IDM. / Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) with a poorer prognosis. Silent atrial fibrillation has been suggested to be frequent after AMI. However, most part of the studies has targeted only paroxysmal or persistent AF. Thus, Reduced Nitric Oxide availability and endothelial dysfunction has been recently recognized as a possible contributor to altered prognosis in AF. Asymmetric dimethylarginine (ADMA) can inhibit nitric oxide synthase and leads to endothelial dysfunction, inflammation and oxidative stress in multiple cardiovascular diseases. However, any study has addressed the relationship between ADMA levels and the occurrence of AF in AMI.We aimed to assess in-hospital and 1-year prognosis in patients experiencing silent AF in AMI and evaluate the potential relationship between dimethylarginines plasma levels and the occurrence AF after acute myocardial infarction.Our first prospective study shows for the first time that silent AF is more frequent than symptomatic AF after AMI and is associated with a worse prognosis.Our second work confirms the impact of silent AF on prognosis, with a prognosis that remains worse one year after the acute phase of MI. Our third work proved that ADMA is independently associated with symptomatic AF after AMI and strengthen the capacity to estimate symptomatic AF occurrence. In conclusion our studies highlight that AF is not a negligible event after AMI, in particular silent AF. That suggests that systematic screening and specific management should be investigated in order to improve outcomes of patients. ADMA appears to be a potential predictor of AF after AMI, because of its significant association.