Division of Cardiology, Sahlgrenska Academy at Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
Europace. 2011 Feb;13(2):262-9. doi: 10.1093/europace/euq418. Epub 2010 Nov 19.
To collect information on the use of the Reveal implantable loop recorder (ILR) in the patient care pathway and to investigate its effectiveness in the diagnosis of unexplained recurrent syncope in everyday clinical practice.
Prospective, multicentre, observational study conducted in 2006-2009 in 10 European countries and Israel. Eligible patients had recurrent unexplained syncope or pre-syncope. Subjects received a Reveal Plus, DX or XT. Follow up was until the first recurrence of a syncopal event leading to a diagnosis or for ≥1 year. In the course of the study, patients were evaluated by an average of three different specialists for management of their syncope and underwent a median of 13 tests (range 9-20). Significant physical trauma had been experienced in association with a syncopal episode by 36% of patients. Average follow-up time after ILR implant was 10±6 months. Follow-up visit data were available for 570 subjects. The percentages of patients with recurrence of syncope were 19, 26, and 36% after 3, 6, and 12 months, respectively. Of 218 events within the study, ILR-guided diagnosis was obtained in 170 cases (78%), of which 128 (75%) were cardiac.
A large number of diagnostic tests were undertaken in patients with unexplained syncope without providing conclusive data. In contrast, the ILR revealed or contributed to establishing the mechanism of syncope in the vast majority of patients. The findings support the recommendation in current guidelines that an ILR should be implanted early rather than late in the evaluation of unexplained syncope.
收集 Reveal 植入式环路记录器（ILR）在患者治疗路径中的使用信息，并研究其在日常临床实践中诊断不明原因复发性晕厥中的有效性。
这是一项 2006 年至 2009 年在 10 个欧洲国家和以色列进行的前瞻性、多中心、观察性研究。合格的患者有复发性不明原因晕厥或先兆晕厥。受试者接受 Reveal Plus、DX 或 XT 治疗。随访直至首次发生导致诊断的晕厥事件复发或随访≥1 年。在研究过程中，患者平均由 3 位不同的专家评估晕厥管理情况，并接受了中位数为 13 次（范围 9-20 次）的检查。36%的患者在晕厥发作时伴有明显的身体创伤。ILR 植入后平均随访时间为 10±6 个月。570 名患者中有随访就诊数据。植入后 3、6 和 12 个月，分别有 19%、26%和 36%的患者复发晕厥。在研究期间的 218 次事件中，ILR 指导诊断了 170 例（78%），其中 128 例（75%）为心脏原因。
在不明原因晕厥患者中进行了大量的诊断测试，但未提供明确的数据。相比之下，ILR 揭示或有助于确定绝大多数患者晕厥的机制。这些发现支持当前指南的建议，即在不明原因晕厥的评估中，应尽早而非晚期植入 ILR。
