Lombardi Federico, Calosso Ezio, Mascioli Giosuè, Marangoni Egidio, Donato Andrea, Rossi Stefano, Pala Massimo, Foti Francesco, Lunati Maurizio
Cardiologia, Dipartimento di Medicina, Chirurgia e Odontoiatria, Osp. San Paolo, Università di Milano, Via A. di Rudinì 8, 20142 Milano, Italy.
Europace. 2005 Jan;7(1):19-24. doi: 10.1016/j.eupc.2004.09.003.
In about 30% of patients with syncope, the responsible mechanisms remain unrecognised. Nevertheless, the possibility of an arrhythmic aetiology remains, however, difficult to rule out.
We therefore monitored with an implantable loop recorder (ILR, Reveal Plus, Medtronic) 34 subjects (60+/-15 years) with at least two unexplained syncopal episodes and negative neurological and cardiovascular work-up.
During a follow-up of 7+/-4 months, syncope occurred in 11 subjects. In nine of them the mechanisms responsible for these events were identified by ILR monitoring: marked bradycardia or asystole (n=6), atrial fibrillation with wide QRS tachycardia (n=1) and sinus rhythm with fine artifacts likely to be due to muscle contractions (n=2). Pre-syncope occurred in seven patients: advanced atrioventricular block (n=3), sinus tachycardia (n=1), and wide QRS tachycardia (n=1) were documented. Thus, when considering all 18 patients with recurrences, a diagnosis was achieved in 53% of subjects. Recognition of the rhythm disorder in seven patients with syncope and four patients with pre-syncope guided patient management.
These data indicate that ILR monitoring facilitates the identification of mechanisms responsible for recurrences and therapeutic management in subjects with syncope or pre-syncope and negative traditional neurological and cardiovascular work-up.
在约30%的晕厥患者中，其病因机制仍未明确。然而，心律失常病因的可能性仍然难以排除。
因此，我们使用植入式循环记录仪（ILR，美敦力公司的Reveal Plus）对34名受试者（年龄60±15岁）进行监测，这些受试者至少有两次不明原因的晕厥发作，且神经学和心血管检查均为阴性。
在7±4个月的随访期间，11名受试者发生了晕厥。其中9名受试者通过ILR监测确定了这些事件的机制：显著心动过缓或心搏停止（n = 6）、伴有宽QRS波心动过速的心房颤动（n = 1）以及可能由肌肉收缩导致的伴有微小伪差的窦性心律（n = 2）。7名患者出现了先兆晕厥：记录到了高度房室传导阻滞（n = 3）、窦性心动过速（n = 一名）和宽QRS波心动过速（n = 1）。因此，在考虑所有18例复发患者时，53%的受试者得到了诊断。对7例晕厥患者和4例先兆晕厥患者的心律失常识别指导了患者的管理。
这些数据表明，ILR监测有助于识别晕厥或先兆晕厥且传统神经学和心血管检查为阴性的受试者复发的病因机制及治疗管理。
