Salih H, Monsel F, Sergent J, Amara W
Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
Ann Cardiol Angeiol (Paris). 2012 Nov;61(5):331-7. doi: 10.1016/j.ancard.2012.08.033. Epub 2012 Oct 1.
Despite recent advances in diagnostic procedures, syncope remains unexplained in 15 to 35% of patients. If implantable loop recorder is a validated diagnostic tool for unexplained syncope, results of this strategy are largely issued from randomized studies. We lack the results of surveys. The aim of this study was to report a single center experience with implantable loop recorders, in patients with unexplained syncope.
A device (Medtronic Reveal DX or XT) was implanted in 31 patients between January 2009 and January 2012. During a mean follow-up of 10.5±8.5 months, loop recording definitively determined that an arrhythmia was the cause of symptoms in 10 patients (32%). Fourteen patients (45%) experienced syncope or pre-syncope. In eight of the 14 patients with syncope, during follow-up, no arrhythmic diagnosis could be made (one patient has been diagnosed as presenting epilepsy and seven as having hypotensive vasovagal syncope). In six patients, the ILR showed an arrhythmic aetiology. Four other patients presented an abnormal ILR result without symptoms. Diagnosis included sinusal arrest in four patients, bradycardia in one patient, advanced atrioventricular block in two patients, ventricular arrythmias in two patients, and supraventricular tachycardia of 180/min in one patient. Therapy was instituted in all patients, in whom an arrhythmic cause was found except one who refused the therapy (six pacemaker, two implantable cardioverter-defibrillator implantations, and one cryoablation of atrioventricular nodal reentrant tachycardia confirmed by an invasive exploration).
In this survey, implantable loop recorder implantation led to the diagnosis of an arrhythmic cause in 32% of patients and excluded an arrhythmic cause in 26% of patient with a mean follow-up of 10.5 months.
尽管诊断方法最近有所进展，但仍有15%至35%的患者晕厥原因不明。如果植入式循环记录仪是不明原因晕厥的有效诊断工具，该策略的结果主要来自随机研究。我们缺乏调查结果。本研究的目的是报告在不明原因晕厥患者中使用植入式循环记录仪的单中心经验。
2009年1月至2012年1月期间，为31例患者植入了一种设备（美敦力Reveal DX或XT）。在平均10.5±8.5个月的随访期间，循环记录明确确定10例患者（32%）的症状原因是心律失常。14例患者（45%）经历了晕厥或先兆晕厥。在14例晕厥患者中的8例中，随访期间无法做出心律失常诊断（1例患者被诊断为癫痫，7例为低血压性血管迷走性晕厥）。6例患者的植入式循环记录仪显示有心律失常病因。另外4例患者植入式循环记录仪结果异常但无症状。诊断包括4例窦性停搏、1例心动过缓、2例高度房室传导阻滞、2例室性心律失常和1例180次/分钟的室上性心动过速。除1例拒绝治疗的患者外，所有发现心律失常病因的患者均接受了治疗（6例植入起搏器，2例植入植入式心脏复律除颤器，1例经侵入性检查证实为房室结折返性心动过速后进行冷冻消融）。
在本次调查中，植入式循环记录仪植入导致32%的患者诊断出心律失常病因，26%的患者排除了心律失常病因，平均随访时间为10.5个月。
