Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Grenadierow 51/59 04 073, Warsaw, Poland.
Europace. 2010 Feb;12(2):230-9. doi: 10.1093/europace/eup367. Epub 2009 Nov 17.
Syncope is a common problem. Demographic and clinical characteristics of patients admitted to different types of centres may vary, physician's adherence to the guidelines has been examined only in a few studies, and the requirements for implantable loop recorders (ILR) have not been well defined. The aim of this study was to (i) compare demographic and clinical characteristics of patients with syncope diagnosed and treated in tertiary electrophysiology cardiac centres and those attending syncope units or general hospitals, (ii) assess how physicians adhere to the published guidelines, and (iii) calculate the requirement for ILR insertion.
In total, 669 consecutive patients with syncope, admitted to 18 electrophysiological cardiac tertiary centres over a mean of 3 months (range 1-10 months), entered a special Internet database called the PL-US (Polish patients with Unexplained Syncope) registry. Detailed demographic and clinical characteristics of the patients, including the results of all diagnostic tests performed, were analysed. Adherence to the guidelines was assessed, based on the published recommendations. The ILR implantation was indicated when (i) all other tests were inconclusive (unexplained syncope) and (ii) syncope associated with injury or presence of organic heart disease or past medical history and ECG suggesting arrhythmic syncope. Syncope of cardiac/arrhythmic origin was the most frequent diagnosis (53%), followed by reflex syncope (33%). Adherence to the guidelines was less than satisfactory-measurement of blood pressure in an upright position, carotid sinus massage, exercise testing, and electrophysiological study were underused, whereas prolonged ECG monitoring and neurological consultations were overused. Unexplained syncope had 58 (9%) patients, and 42 (72%) of them had indication for ILR which accounts for 6% of the whole study population. The calculated need for ILR was 222 implants/million inhabitants/year.
Patients with syncope admitted to the tertiary electrophysiology cardiac centres are a highly selected group of patients with syncope and differ in their characteristics as well as underlying diseases to those managed at general hospitals, outpatient clinics, or special syncope units. In Poland, the adherence to the published guidelines is far from satisfactory. At least 6% of all consecutive patients with syncope are candidates for ILR insertion.
晕厥是一种常见问题。在不同类型中心就诊的晕厥患者的人口统计学和临床特征可能有所不同，仅少数研究检查了医生对指南的遵循情况，并且尚未明确植入式环路记录器（ILR）的要求。本研究的目的是：（i）比较在三级电生理心脏中心诊断和治疗的晕厥患者与在晕厥单位或综合医院就诊的患者的人口统计学和临床特征；（ii）评估医生对已发表指南的遵循情况；（iii）计算 ILR 插入的需求。
在平均 3 个月（范围 1-10 个月）内，共有 669 例连续晕厥患者入住 18 家三级电生理心脏中心，并输入了一个名为 PL-US（波兰不明原因晕厥患者）的特殊互联网数据库。分析了患者的详细人口统计学和临床特征，包括所有进行的诊断测试结果。根据已发表的建议评估对指南的遵循情况。当（i）所有其他检查均不确定（不明原因晕厥）和（ii）晕厥与损伤或器质性心脏病或既往病史相关且心电图提示心律失常性晕厥时，建议植入 ILR。心源性/心律失常性起源的晕厥是最常见的诊断（53%），其次是反射性晕厥（33%）。对指南的遵循情况不尽如人意-直立位血压测量、颈动脉窦按摩、运动试验和电生理研究的使用不足，而延长心电图监测和神经科会诊的使用过度。不明原因晕厥有 58 例（9%）患者，其中 42 例（72%）有植入 ILR 的指征，占研究人群的 6%。计算出的 ILR 需求为 222 例/百万居民/年。
入住三级电生理心脏中心的晕厥患者是一组高度选择的晕厥患者，其特征和潜在疾病与在综合医院、门诊或特殊晕厥单位就诊的患者不同。在波兰，对已发表指南的遵循情况远非令人满意。至少有 6%的连续晕厥患者是 ILR 植入的候选者。
