不明原因晕厥患者基于长程心电数据的病因分析

Etiological analysis of long-term electrocardiogram data in patients with unexplained syncope

目的探讨长程心电数据对于分析不明原因晕厥的价值及要素。方法本研究为单中心回顾性研究。连续选择2017年3月21日至2021年3月20日在四川省人民医院接受植入型心电监测仪(ICM)植入的患者,分析植入后晕厥等事件发生与心律失常及相关临床情况间的关系,分析和总结晕厥病因检出率、病因分类以及需要临床干预程度。结果入选的96例患者,年龄64(52,73)岁,年龄范围13~86岁,其中男55例。随访中,49例再发晕厥,其中确定晕厥与心律失常相关28例,排除心律失常所致晕厥21例(15例患者最终明确了晕厥原因);暂未发生晕厥的患者47例,其中有9例发现有需临床干预的心律失常,但未能肯定这些心律失常与晕厥的关系。结论不明原因晕厥患者是否有心电监测状态下的晕厥再发,是确诊的关键;晕厥再发过程中记录到的心电资料,为不明原因晕厥患者提供了预期和预期以外的有诊断价值的数据。

Objective To explore the value and factors of long-term electrocardiogram data for diagnosis of unexplained syncope.Methods This study was a single center retrospective study.The patients who received insertable cardiac monitor(ICM)implantation in Sichuan Provincial People’s Hospital from March 21,2017 to March 20,2021 were consecutively selected.The relationship between post-implantation events,arrhythmias and related clinical conditions was analyzed.The detection rate of syncope etiology,etiological classification and the degree of clinical intervention needed were analyzed and summarized.Results Totally of 96 patients,the median age was 64(52,73),age range13 to 86 years old,including 55 males.During follow-up,49 patients had recurrent syncope,28 patients were confirmed to be related to arrhythmia,and 21 patients with syncope were not caused by arrhythmia(15 patients finally identified the etiology of syncope by follow-up examination,and 6 patients were still unknown).A total of 43 patients were diagnosed,with a diagnosis rate of 44.8%.No further syncope occurred in 47 patients,9 of whom were found arrhythmias requiring clinical intervention.Among 96 patients,52 needed clinical intervention.Based on ICM data,37 patients needed antiarrhythmic intervention,and 33 patients actually received treatment.Conclusion During the follow-up of patients with unexplained syncope,whether there is recurrence of syncope under electrocardiogram monitoring is the key to diagnosis.The electrocardiogram data recorded during the recurrence of syncope provide both anticipated and unexpected diagnostic value data for patients with unexplained syncope.