Frangini Patricia A, Cecchin Frank, Jordao Ligia, Martuscello Maria, Alexander Mark E, Triedman John K, Walsh Edward P, Berul Charles I
Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Pacing Clin Electrophysiol. 2008 Mar;31(3):338-43. doi: 10.1111/j.1540-8159.2008.00995.x.
An insertable loop recorder (ILR) in patients with infrequent syncope or palpitations may be useful to decide management strategies, including clinical observation, medical therapy, pacemaker, or implantable cardioverter defibrillator (ICD). We sought to determine the diagnostic utility of the Reveal ILR (Medtronic, Inc., Minneapolis, MN, USA) in pediatric patients.
Retrospective review of clinical data, indications, findings, and therapeutic decision in 27 consecutive patients who underwent ILR implantation from 1998-2007.
The median age was 14.8 years (2-25 years). Indications were syncope in 24 patients and recurrent palpitations in three. Overall, eight patients had structural heart disease (six congenital heart disease, one hypertrophic cardiomyopathy, one Kawasaki), five had previous documented ventricular arrhythmias with negative evaluation including electrophysiology study, and three patients had QT prolongation. Tilt testing was performed in 10 patients, of which five had neurocardiogenic syncope but recurrent episodes despite medical therapy. After median three months (1-20 months), 17 patients presented with symptoms and the ILR memory was analyzed in 16 (no episode stored in one due to full device memory), showing asystole or transient atrioventricular (AV) block (2), sinus bradycardia (6), or normal sinus rhythm (8). Among asymptomatic patients, 3/10 had intermittent AV block or long pauses, automatically detected and stored by the ILR. In 19 of 20 patients, ILR was diagnostic (95%) and five subsequently underwent pacemaker implantation, while seven patients remained asymptomatic without ILR events. Notably, no life-threatening events were detected. The ILR was explanted in 22 patients after a median of 22 months, two due to pocket infection, 12 for battery depletion and eight after clear documentation of nonmalignant arrhythmia.
The ILR in pediatrics is a useful adjunct to other diagnostic studies. Patient selection is critical as the ILR should not be utilized for malignant arrhythmias. A diagnosis is attained in the majority of symptomatic patients, predominantly bradyarrhythmias including pauses and intermittent AV block.
对于晕厥或心悸发作不频繁的患者，植入式循环记录仪（ILR）可能有助于确定治疗策略，包括临床观察、药物治疗、起搏器或植入式心脏复律除颤器（ICD）。我们试图确定Reveal ILR（美敦力公司，明尼阿波利斯，明尼苏达州，美国）在儿科患者中的诊断效用。
回顾性分析1998年至2007年连续27例接受ILR植入患者的临床资料、适应证、检查结果及治疗决策。
中位年龄为14.8岁（2 - 25岁）。适应证为24例患者有晕厥，3例有反复发作的心悸。总体而言，8例患者有结构性心脏病（6例先天性心脏病、1例肥厚型心肌病、1例川崎病），5例既往有记录的室性心律失常且评估为阴性，包括电生理检查，3例患者有QT延长。10例患者进行了倾斜试验，其中5例有神经心源性晕厥，但尽管接受了药物治疗仍有反复发作。中位随访3个月（1 - 20个月）后，17例患者出现症状，对其中16例患者的ILR记录进行了分析（1例因设备内存已满未存储到发作事件），结果显示为心脏停搏或短暂房室传导阻滞（2例）、窦性心动过缓（6例）或正常窦性心律（8例）。在无症状患者中，10例中有3例有间歇性房室传导阻滞或长间歇，由ILR自动检测并存储。20例患者中有19例（95%）通过ILR明确了诊断，其中5例随后接受了起搏器植入，7例患者无ILR事件仍无症状。值得注意的是，未检测到危及生命的事件。22例患者在中位22个月后取出了ILR，2例因囊袋感染，12例因电池耗尽，8例在明确记录为非恶性心律失常后取出。
儿科患者中的ILR是其他诊断研究的有用辅助手段。患者选择至关重要，因为ILR不应应用于恶性心律失常。大多数有症状的患者可通过ILR明确诊断，主要为缓慢性心律失常，包括长间歇和间歇性房室传导阻滞。
