植入型心电监测仪对不明原因晕厥的诊断价值

Clinical practice of the insertable cardiac monitor for unexplained syncope

目的由于发作的突然性及偶然性，晕厥的原因往往很难通过传统检查方法得以明确。本文探讨植入型心电监测仪（ICM）对不明原因晕厥的临床诊断价值。方法人选2013年8月1日至2016年12月31日在浙江大学医学院附属第一医院心内科就诊的不明原因晕厥的33例患者，植入ICM，术后每3个月随访1次直至出现晕厥事件。随访时调取ICM记录的心电数据进行回顾性分析。结果平均随访（705．0±389．4）d，2例患者死亡，7例患者出现晕厥，ICM共记录到1例室性心动过速、1例心室颤动及5例心室停搏。其中5例患者依据ICM监测结果，植入相应的治疗性器械，之后随访未再出现晕厥。结论ICM可以有效提高不明原因晕厥患者的诊断率，且具有较高的安全性。对于不明原因的晕厥推荐尽早植入ICM。

Objective Due to their sporadic and infrequent occurrences, the diagnosis of the unexplained syncope is hampered by conventional monitoring methods. This study is designed to investigate the application of the insertable cardiac monitor （ ICM ） for the diagnosis of the unexplained syncope. Methods From August 1,2013 to December 31,2016, 33 patients with unexplained syncope in The First Affiliated Hospital, College of Medicine, Zhejiang University were enrolled. The event of the arrhythmia during the syncope occurrences were monitored by ICM. Results During the follow-up of（ 705.0± 389.4 ） d, 2 patients died and 7 patients attacked syncope. Seven arrhythmia events were detected by ICM, including 1 case of Vehicular fibrillation, 1 case of ventricular tachycardia and 5 cases of ventricuiar arrest. The patients who received the optimization of antiarrhythmic therapy had been free from syncope. Conclusion Unexplained syncope is a common condition with a significant impact both on the patient and heahhcare expenditure. The diagnostic rates of unexplained syncope can be significandy improved by the ICM. Thus, ICM is recommended for the early diagnosis of unexplained syncope.