置入式Holter诊断不明原因晕厥的应用研究

Efficacy of implantable loop recorders in establishing symptom-rhythm correlation in patients with unexplained syncope

目的探讨置入式Holter(ILR)在诊断不明原因晕厥和指导治疗中的临床价值。方法入选2002年10月至2005年5月求治的不明原因晕厥患者10例,男性4例,女性6例,平均年龄(41±22)岁。有2次以上晕厥或近似晕厥史平均为(4.5±1.4)次/例,经常规检查未能明确晕厥原因。均选用Medtronic公司RevealPlus(9526型ILR。结果10例患者平均随访(17.8±6.6)个月,ILR有效监测时间平均(15.3±3.6)个月,监测期内6例患者再发晕厥或近似晕厥24次。7例患者手动触发19段心电图,ILR自动触发记录460段心电图,共记录211段心电图为心律失常事件。根据症状-心律相关性,7例患者明确为心律失常性晕厥,1例患者明确为非心律失常性晕厥;2例仍不能明确晕厥原因。提示ILR诊断晕厥的效率为80%。10例依据ILR监测结果得到相应治疗,晕厥发作减少或消失。结论ILR用于诊断不明原因晕厥和先兆晕厥安全、高效、长程,可证实或排除患者的部分晕厥或近似晕厥系心律失常所致;具有微创、简单、监测期长、信息量大等优点,可作为现有晕厥诊断方法的重要补充。加强患者的依从性和动态优化工作参数,将进一步提高ILR的诊断价值。

Objective To evaluate the efficacy of the implantable loop recorder （ILR） in establishing symptom-rhythm correlation in patients with unexplained syncope. Methods Implantable loop recorders （ ILR, Reveal Plus 9526, Medtronic Inc. ） were implanted in 10 patients [aged 14 - 78 （41 ± 22 ） years, 6 female] with unexplained syncope from October 2002 to May 2005. Syncopal episodes were （4. 5±1.4） patients. Results During the monitoring period 18 -21 （ 15.3±3.6） months ] , there were 24 times syncopal episodes in 6 patients. A total of 211 arrhythmical events were documented by ILR in 7 patients and symptom-rhythm correlation could be established in these 7 patients. In 2 patients, there were no recurrent syncopes and no arrhythmical events could be recorded. In 1 patient, syncope was caused by reasons other than arrhythmia. Conclusion ILR is useful in determining the presence or absence of an arrhythmia during symptoms of syncope when conventional diagnostic testing, such as electrocardiogram, Holter monitoring, and/or external loop recording, is inconclusive.