Yeung B, McLeod K
Department of Surgery, NHS Greater Glasgow & Clyde, Glasgow Royal Infirmary, Glasgow, UK.
Heart. 2008 Jul;94(7):888-91. doi: 10.1136/hrt.2007.121855. Epub 2007 Jul 30.
To evaluate use of the implantable loop recorder in children.
Royal Hospital for Sick Children, Glasgow, UK.
Retrospective study of children who had an implantable loop recorder between September 1998 and October 2005.
38 devices were implanted in 34 children. Median age at implantation 11.3 years (range 1.8-17.6); median follow-up period 15 months (range 2-58). The main presenting complaint was syncope in 26 (76.5%), seizures in 6 (17.6%) and palpitations in 2 (5.9%). After implantation, 19 (55.9%) patients had symptom recurrence. Of these, 11 were shown to have sinus rhythm during symptoms and 8 had an abnormal ECG. Four patients had asystole >3 seconds and were diagnosed with reflex asystolic syncope; 2 had polymorphic ventricular tachycardia. One patient who already had a diagnosis of long QT syndrome was shown to have ventricular ectopy during symptoms and beta-blockers were increased. One patient had transient complete heart block during symptoms but refused a pacemaker. In almost half the patients (44.1%), symptoms resolved after implantation. Complications requiring removal of the device occurred in 6 (15.8%) implants.
In children with syncope and palpitations, the implantable loop recorder appears to be an excellent method of effecting a "cure" in almost 50% of subjects. For those who remain symptomatic, it is successful in determining cardiac rhythm during symptoms, but the complication rate in children may be higher than that of adults.
评估植入式环路记录器在儿童中的应用。
英国格拉斯哥皇家儿童医院。
对1998年9月至2005年10月期间植入植入式环路记录器的儿童进行回顾性研究。
34名儿童植入了38个装置。植入时的中位年龄为11.3岁（范围1.8 - 17.6岁）；中位随访期为15个月（范围2 - 58个月）。主要就诊症状为晕厥26例（76.5%），癫痫发作6例（17.6%），心悸2例（5.9%）。植入后，19例（55.9%）患者症状复发。其中，11例在症状发作时显示为窦性心律，8例心电图异常。4例患者出现心脏停搏>3秒，被诊断为反射性心搏停止性晕厥；2例有多形性室性心动过速。1例已诊断为长QT综合征的患者在症状发作时出现室性早搏，增加了β受体阻滞剂的用量。1例患者在症状发作时出现短暂性完全性心脏传导阻滞，但拒绝植入起搏器。几乎一半的患者（44.1%）在植入后症状缓解。6例（15.8%）植入装置出现需要取出装置的并发症。
对于有晕厥和心悸的儿童，植入式环路记录器似乎是一种能使近50%的患者“治愈”的极佳方法。对于仍有症状的患者，它能成功确定症状发作时的心律，但儿童的并发症发生率可能高于成人。
