心律失常性晕厥的诊断与治疗

Diagnosis and Therapy of Syncope Associated With Arrhythmias

心律失常是心源性晕厥中的常见原因,导致晕厥的心律失常有心动过速和心动过缓两类,临床上可以通过有创或无创的心电监测及电生理检查明确其诊断,长时程心电图监测大都能发现问题。可穿戴心电图记录仪及移动遥测装置在心源性晕厥的判断上优于常规心电图。如果确诊心律失常是晕厥的主要原因,就可以针对该心律失常采用相应措施。对于因为心动过缓出现的晕厥心脏起搏器有显著效果。过速型心律失常引起的晕厥常需要进行消融治疗。植入型心律转复除颤器(ICD)对于左室功能降低、室性心动过速或室颤同时有晕厥的患者而无其也可解释的原因时有良好的植入指征。

Cardiac arrhythmias including bradycardia and tachycardia are the most common cause of cardiac syncope. Noninvasive and invasive electrocardiographic monitoring and electrophysiological testing contribute to the diagnosis. Longterm ECG monitoring is often warranted. In this regard, among wearable ECG event recorders, mobile cardiac outpatient telemetry devices have been shown to be superior to conventional event recorders in syncope patients. In the case of cardiac arrhythmias being the primary cause of syncope, treatment decisions are directed at the specific documented arrhythmia. Cardiac pacemakers are highly effective for bradyarrhythmias. Tachyarrhythmic origins of syncope often lead to ablation. An implantable cardioverter-defibrillator （ICD） is indicated in patients with syncope and depressed cardiac function, and VT or fibrillation without correctable cause.