Nierop P R, van Mechelen R, van Elsäcker A, Luijten R H, Elhendy A
Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Pacing Clin Electrophysiol. 2000 Oct;23(10 Pt 1):1532-8. doi: 10.1046/j.1460-9592.2000.01532.x.
Ambulatory ECG monitoring in patients with recurrent syncope is nondiagnostic in the majority of cases. Recently, an ECG implantable loop recorder (ILR) has been introduced. The ILR performs continuous ECG monitoring over a period of at least 14 months. From February 1997 to September 1999, 35 patients underwent implantation of an ILR. During a mean follow-up of 11 +/- 8 months, 24 (69%) patients had recurrent syncope or presyncope events. Four (11%) patients were not capable of activating the ILR to save the event. A symptom-rhythm correlation could be studied in 20 (83%) of 24 patients. Forty of 44 recurrences were captured by the ILR. There were 14 (40%) patients with at least one syncopal episode. An arrhythmic cause for syncope was found in eight of them (bradycardia in four and tachycardia in four). In the other six patients the heart rhythm was normal. In 17 (49%) patients with 1-year follow-up, the mean syncope event rate 12 months before ILR implantation was 4.7 +/- 2.4, whereas the mean syncope event rate 12 months after ILR implantation was 1.3 +/- 0.7 (P < 0.01). Resolution of symptoms was observed in 6 (17%) patients. These patients were significantly younger than patients without resolution (50 +/- 18 vs 69 +/- 14 years, p < 0.01) and five were women. Three (9%) patients died during follow-up, all of them were noncompliant during their follow-up. In conclusion, the ILR made symptom-rhythm correlation possible in 83% of patients with recurrent syncope. Syncope recurrences decreased significantly after implantation of the device, especially in the younger patients. Noncompliant patients had a high mortality rate.
动态心电图监测对复发性晕厥患者来说，在大多数情况下无法做出诊断。最近，一种可植入式心电环路记录器（ILR）问世了。ILR可进行至少14个月的连续心电图监测。1997年2月至1999年9月，35例患者接受了ILR植入术。在平均11±8个月的随访期内，24例（69%）患者出现了复发性晕厥或晕厥前事件。4例（11%）患者无法激活ILR来保存事件记录。24例患者中有20例（83%）可进行症状与节律相关性研究。44次复发事件中有40次被ILR捕获。有14例（40%）患者至少有一次晕厥发作。其中8例发现晕厥的心律失常原因（4例为心动过缓，4例为心动过速）。另外6例患者心律正常。在17例（49%）随访1年的患者中，ILR植入前12个月的平均晕厥事件发生率为4.7±2.4，而ILR植入后12个月的平均晕厥事件发生率为1.3±0.7（P<0.01）。6例（17%）患者症状得到缓解。这些患者明显比未缓解症状的患者年轻（50±18岁对69±14岁，p<0.01），且5例为女性。3例（9%）患者在随访期间死亡，他们在随访期间均不配合治疗。总之，ILR使83%的复发性晕厥患者的症状与节律相关性研究成为可能。该装置植入后晕厥复发显著减少，尤其是在年轻患者中。不配合治疗的患者死亡率较高。
