植入式心电记录器在心房颤动射频消融术后随访中的应用

Application of implantable loop recorder in follow-up of atrial fibrillation radiofrequency ablation

目的探讨植入式心电记录器(ILR)在观察心房颤动射频消融术后疗效中的价值。方法收集2010年10月至2012年8月心房颤动射频消融术后复发患者7例,其中男性2例,女性5例;年龄23～67岁,平均年龄51岁。经常规检查未能明确复发原因,根据病情分别选择植入Medtronic公司RevealRDX9528型、Reveal XTTM9529型ILR监测复发时的心电事件,以帮助确诊。结果 7例植入ILR的患者平均随访(12.7±5.1)个月。随访期内7例患者共记录心电图191段,其中患者手动触发记录49段,ILR自动触发记录142段,64段心电图为心律失常事件。根据症状-心律相关性,监测到6例患者出现胸闷、晕厥等症状,其中5例患者明确为心律失常性事件引起,1例为非心律失常性事件引起。1例无症状发作。提示ILR诊断复发原因的效率为85.71%。根据ILR监测结果明确病因的6例患者得到进一步治疗,症状发作好转或减少。结论 ILR用于诊断心房颤动射频消融术后复发具有安全、高效、监测时间长、信息量大等优点,动态优化ILR系统,将进一步提高ILR在临床诊断、疗效追踪、指导治疗等方面的临床应用价值。

Objective To evaluate the efficacy of implantable loop recorder（ILR） for paroxysmal atrial fibrillation treated by radiofrequency ablation.Methods A total of 7 patients with artrial fibrillation recurrence after radiofrequency ablation were enrolled,male 2,female 5,aged 23-67 years old,mean age 51 years old.The ILR（RevealR DX9528,Reveal XTTM 9529,Medtronic Inc.） was implanted to help diagnose.Results During the monitoring period[（12.7 ± 5.1） months],191 times events,including 64 arrhythmia events,were documented in 7 patients.The ILR were manually recorded 49 times,automatically recorded 142 times.For symptoms-irregular correlation,6 cases were monitored chest tightness and syncope,in which 5 cases were caused by arrhythmic events and 1 cases were caused by non-arrhythmia.No recurrent and arrhythmia events were recorded for only one patient.The diagnosis efficiency of recurrence was 85.71 %.The 6 cases checked by ILR were performed further treatment,which were improved or reduced the onset symptoms.Conclusion It is demonstrated that ILR has the advantages of safety,efficacy tracking,long-time monitoring and large amount of information.The optimized dynamic system will further improve the application of ILR in clinical diagnosis,tracking effect and guiding the treatment application.