Bass E B, Curtiss E I, Arena V C, Hanusa B H, Cecchetti A, Karpf M, Kapoor W N
Division of Internal Medicine, Johns Hopkins Hospital, Baltimore, Md.
Arch Intern Med. 1990 May;150(5):1073-8.
To determine the incremental yield of ambulatory monitoring in the evaluation of syncope, three serial 24-hour Holter recordings were obtained in a consecutive series of 95 patients with syncope, the cause of which was not explained by history, physical examination, or 12-lead electrocardiogram. The mean age of patients was 61 years and 41% were men. Major electrocardiographic abnormalities were found in 26 patients (27%), including unsustained ventricular tachycardia (19 patients), pauses of at least 2 seconds (8 patients), profound bradycardia (1 patient), and complete heart block (1 patient). The first 24-hour Holter recording had at least one major abnormality in 14 patients (15%) (95% confidence interval, 8.3% to 23.4%). Of the 81 patients without a major abnormality on the first Holter recording, the second Holter recording had major abnormalities in 9 (11%) (95% confidence interval, 5.1% to 20.0%). Of the 72 patients without a major abnormality on the first two Holter recordings, only 3 patients (4.2%) had a major abnormality on the third Holter recording (95% confidence interval, 0.8% to 11.7%). Four factors were significantly associated with an increased likelihood of a major abnormality on 72 hours of monitoring: age above 65 years (relative risk, 2.2), male gender (relative risk, 2.0), history of heart disease (relative risk, 2.2), and an initial nonsinus rhythm (relative risk, 3.5). These results suggest that 24 hours of Holter monitoring is not enough to identify all potentially important arrhythmias in patients with syncope. Monitoring may need to be extended to 48 hours if the first 24-hour Holter recording is normal.
为了确定动态监测在晕厥评估中的额外诊断价值，我们对95例晕厥患者进行了连续三次24小时动态心电图记录，这些患者的晕厥原因无法通过病史、体格检查或12导联心电图解释。患者的平均年龄为61岁，41%为男性。26例患者（27%）发现主要心电图异常，包括非持续性室性心动过速（19例）、至少2秒的停搏（8例）、严重心动过缓（1例）和完全性心脏传导阻滞（1例）。第一次24小时动态心电图记录有至少一项主要异常的患者有14例（15%）（95%置信区间，8.3%至23.4%）。在第一次动态心电图记录无主要异常的81例患者中，第二次动态心电图记录有主要异常的有9例（11%）（95%置信区间，5.1%至20.0%）。在前两次动态心电图记录无主要异常的72例患者中，只有3例（4.2%）在第三次动态心电图记录时有主要异常（95%置信区间，0.8%至11.7%）。四个因素与72小时监测出现主要异常的可能性增加显著相关：年龄大于65岁（相对风险，2.2）、男性（相对风险，2.0）心脏病史（相对风险，2.2）和初始非窦性心律（相对风险，3.5）。这些结果表明，24小时动态心电图监测不足以识别晕厥患者所有潜在的重要心律失常。如果第一次24小时动态心电图记录正常，监测可能需要延长至48小时。
