植入型心电事件记录仪在不明原因晕厥中的应用价值:单中心经验

The value of implantable loop recorder in unexplained syncope: single center experience

目的探讨植入型心电事件记录仪(ILR)在不明原因晕厥患者中的应用价值,并筛选可能的心律失常源性晕厥预测因素。方法连续入选2013年1月至2018年10月在大连医科大学附属第一医院诊断为不明原因晕厥,且植入ILR的患者37例,年龄(59±19)岁,男24例。植入后进行常规随访,每3~6个月进行1次随访,主要随访内容:症状、程控事件、是否发生晕厥。如患者发生晕厥,通知回院就诊,接受程控和心电学检查,分析晕厥病因及心律失常类型和相关危险因素。结果共22例(59.46%,22/37)患者记录到晕厥事件,其中9例为窦性心动过缓或窦性停搏,6例为三度或高度房室传导阻滞,1例为室性心动过速,2例为室上性心动过速,4例为心房颤动(房颤)伴RR长间歇(>2 s),在植入后(187.73±177.12)d发生晕厥事件。1例患者记录到房颤伴RR长间歇,但未发生晕厥。16例患者植入永久起搏器,1例患者植入心律转复除颤器,2例患者行导管消融治疗。对性别、年龄、合并基础疾病、植入前晕厥次数、心电信息等进行分析发现,动态心电图中存在RR长间歇(>2 s)是预测晕厥发作的影响因素。结论植入ILR可使不明原因晕厥患者获得明确诊断并接受相应治疗,ILR是明确晕厥病因的有效手段之一。动态心电图中存在RR长间歇(>2 s)是心律失常原因晕厥的重要预测因素。

Objective To explore the application value of implantable loop recorder(ILR)in patients with unexplained syncope,and to screen the possible predictors of arrhythmogenic syncope.Methods Thirty-severn patients with syncope of unknown cause and implanted with ILR were selected from January 2013 to October 2018 in the First Affiliated Hospital of Dalian Medical University,with an average age of(59±19)years,and 24 males.After implantation,routine follow-up was carried out every 3 to 6 months.The main follow-up contents were symptoms,programmed events and syncope.Patients with syncope were notified to return to hospital for treatment.Results Syncope events were recorded in 22 patients(59.46%,22/37),including 9 cases of sinus bradycardia or sinus arrest,6 cases of third degree or high-grade atrioventricular block,1 case of ventricular tachycardia,2 cases of supraventricular tachycardia,4 cases of atrial fibrillation(AF)with long RR interval(>2 s).Syncope events occurred in(187.73±177.12)days after implantation.AF with long RR interval was recorded in one patient,but no syncope occurred.Sixteen patients were implanted with permanent pacemaker,1 patient with cardioverter defibrillator(ICD),and 2 patients underwent catheter ablation.In this study,sex,age,combined basic diseases,the number of syncope before implantation and electrocardiogram(ECG)information were analyzed.It was found that long RR interval(>2 s)in Holter was a predict or of syncope.Conclusion The patients with unexplained syncope can be diagnosed and treated.ILR is one of the effective methods to determine the cause of syncopewith ILR implantation.The presence of long RR interval(>2 s)in Holter is an important predictor of arrhythmogenic syncope.