Krahn A D, Klein G J, Yee R, Skanes A C
Division of Cardiology, University of Western Ontario, London, Canada.
Am Heart J. 2001 May;141(5):817-21. doi: 10.1067/mhj.2001.114196.
The purpose of this study was to assess the diagnostic value of recording the cardiac rhythm during presyncope in patients undergoing monitoring for undiagnosed syncope.
Eighty-five patients (age, 59 +/- 18 years; 44 men, 41 women) with recurrent unexplained syncope underwent prolonged monitoring with an implantable loop recorder. Patients were examined for syncope, which was either recurrent or associated with at least 2 presyncopal episodes. Patients had a mean of 5.1 +/- 5.5 syncopal episodes in the previous 12 months, and 70% of patients had symptoms for >2 years. Sixty-two (73%) patients had recurrent symptoms during a 12-month follow-up period. Of 150 recurrent events captured by the implantable loop recorder, there were 38 (25%) episodes of syncope and 112 (75%) episodes of presyncope. Syncope alone recurred in 12 patients, presyncope in 25, and both in 16. An arrhythmia was present in 64% of syncopal events (bradycardia in 16, tachycardia in 2) versus 25% for presyncopal events (bradycardia in 7, tachycardia in 3, P =.001). An arrhythmia was detected in 9 (56%) of the 16 patients with both syncope and presyncope, which was present in all recorded episodes of syncope compared with 6 of 9 presyncopal episodes. Patient-related failure to freeze the device after symptoms occurred in 21 (36%) of 59 syncopal events compared with 15 (12%) of 127 presyncopal events (P =.0001).
Syncope is more likely to be associated with an arrhythmia than is presyncope in patients undergoing extended monitoring. Presyncope is a nonspecific end point that is frequently associated with sinus rhythm. Patients undergoing extended monitoring for syncope should continue to be monitored after an episode of presyncope unless an arrhythmia is detected.
本研究旨在评估在对不明原因晕厥患者进行监测期间记录晕厥前期心律的诊断价值。
85例（年龄59±18岁；男性44例，女性41例）不明原因反复晕厥患者接受了植入式循环记录仪的长期监测。对患者进行晕厥检查，晕厥为反复发生或伴有至少2次晕厥前期发作。患者在过去12个月中平均有5.1±5.5次晕厥发作，70%的患者症状持续超过2年。62例（73%）患者在12个月的随访期内有反复症状。在植入式循环记录仪记录的150次反复事件中，有38次（25%）为晕厥发作，112次（75%）为晕厥前期发作。单纯晕厥复发12例，晕厥前期发作25例，两者均有16例。64%的晕厥事件存在心律失常（缓慢性心律失常16例，快速性心律失常2例），而晕厥前期事件为25%（缓慢性心律失常7例，快速性心律失常3例，P = 0.001）。在16例既有晕厥又有晕厥前期发作的患者中，9例（56%）检测到心律失常，在所有记录的晕厥发作中均存在心律失常，而在9次晕厥前期发作中有6次存在。59次晕厥事件中有21次（36%）因患者相关原因在症状出现后未能冻结设备，而127次晕厥前期事件中有15次（12%）出现这种情况（P = 0.0001）。
在接受长期监测的患者中，晕厥比晕厥前期更可能与心律失常相关。晕厥前期是一个非特异性终点，常与窦性心律相关。对晕厥进行长期监测的患者在晕厥前期发作后应继续监测，除非检测到心律失常。
