Gula Lorne J, Krahn Andrew D, Massel David, Skanes Allan, Yee Raymond, Klein George J
Division of Cardiology, University of Western Ontario, London, Ontario, Canada.
Am Heart J. 2004 Apr;147(4):644-8. doi: 10.1016/j.ahj.2003.10.036.
The purpose of the current study was to determine the optimal duration of external loop recorder (ELR) monitoring in patients with presyncope or syncope and to identify factors that predict failure to activate the device effectively.
A multivariate analysis was performed using data from the Comparison Of Loop Recorders Against Holter in Patients with Syncope (COLAPS) trial, a prospective study comparing diagnostic utility of ELRs and Holter monitors for assessment of syncope.
Patients with failure to effectively activate ELRs were compared to those who were successful. This analysis was performed separately for failure of test transmission and for failure to successfully record and transmit data from symptomatic episodes. Patient characteristics were compared among the groups to determine risk factors for device failure.
Among 78 patients who received ELRs, a test transmission was successfully performed by 84.5% of patients. Twenty-one percent of diagnoses were made within 48 hours, 50% at 15 days, and 90% at 33 days. Patients performing a successful test transmission were more familiar with technology, with ability to use a bank automatic teller machine being a significant independent predictor. Patients with a successful test transmission were, in turn, significantly more likely to record and transmit data from symptomatic episodes. Patients living alone were much less likely to use the loop recorder effectively. The presence of factors that may influence motivation to reach a diagnosis (degree of worry/fear of symptoms and impact on daily life) were associated with successful use of the device in a univariate analysis.
ELRs should be worn for at least 30 days to maximize their diagnostic yield. Patients who are unfamiliar with technology, live alone, or have low motivation to reach a diagnosis have a lower diagnostic yield from ELRs for assessment of syncope.
本研究旨在确定使用体外循环记录仪（ELR）监测前驱晕厥或晕厥患者的最佳时长，并识别预测设备未能有效激活的因素。
使用来自晕厥患者环路记录仪与动态心电图比较（COLAPS）试验的数据进行多变量分析，这是一项前瞻性研究，比较了ELR和动态心电图监测仪在评估晕厥方面的诊断效用。
将未能有效激活ELR的患者与成功激活的患者进行比较。分别针对测试传输失败以及未能成功记录和传输症状发作数据的情况进行此分析。比较各组患者的特征以确定设备故障的危险因素。
在78例接受ELR的患者中，84.5%的患者成功进行了测试传输。21%的诊断在48小时内做出，50%在15天内做出，90%在33天内做出。成功进行测试传输的患者对技术更熟悉，能够使用银行自动取款机是一个显著的独立预测因素。成功进行测试传输的患者反过来更有可能记录和传输症状发作的数据。独居患者有效使用环路记录仪的可能性要低得多。在单变量分析中，可能影响确诊动机的因素（对症状的担忧/恐惧程度以及对日常生活的影响）与设备的成功使用相关。
ELR应佩戴至少30天以最大化其诊断率。不熟悉技术、独居或确诊动机低的患者使用ELR评估晕厥时的诊断率较低。
