Solbiati Monica, Sheldon Robert Stanley
Division of Medicine and Pathophysiology, Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy.
Libin Cardiovascular Institute of Alberta, University of Calgary, 1403 29 St. NW, Calgary, AB T2N 2T9, Canada.
Auton Neurosci. 2014 Sep;184:33-9. doi: 10.1016/j.autneu.2014.05.012. Epub 2014 May 27.
The ECG registration during syncope allows physicians either to confirm or exclude an arrhythmia as the mechanism of syncope. Implantable loop recorders have an over-writeable memory buffer that continuously records and deletes the patient's ECG for up to three years. Many studies have analyzed the utility of implantable loop recorders in recurrent unexplained or high risk syncope. These studies suggest that early use of the ILR provides more and earlier diagnoses and could help in selecting patients with vasovagal syncope and prolonged asystolic pauses who might benefit from pacemaker therapy. However many questions remain, including its performance in the community by physicians with a range of experience in diagnosing syncope. Furthermore there is no evidence that the use of the ILR changes outcome. Numerous attempts have been made to determine whether patients with predominantly cardioinhibitory syncope benefit from permanent pacemakers, especially if symptoms are frequent and debilitating. While the first open label trials of pacemakers in the treatment of vasovagal syncope showed promising results, this effect has not been confirmed by blinded randomized clinical trials. More recent data seem to suggest that patients over 40years with severe asystolic vasovagal syncope might benefit from permanent pacemakers.
晕厥期间的心电图记录可使医生确认或排除心律失常作为晕厥的机制。植入式循环记录仪有一个可重写的内存缓冲区，可连续记录和删除患者的心电图长达三年。许多研究分析了植入式循环记录仪在复发性不明原因或高危晕厥中的效用。这些研究表明，早期使用植入式循环记录仪可提供更多、更早的诊断，并有助于筛选出可能从起搏器治疗中获益的血管迷走性晕厥和长时间心脏停搏的患者。然而，仍有许多问题存在，包括不同晕厥诊断经验的医生在临床中使用该设备的情况。此外，没有证据表明使用植入式循环记录仪会改变预后。人们进行了大量尝试，以确定主要为心脏抑制性晕厥的患者是否能从永久性起搏器中获益，特别是当症状频繁且使人衰弱时。虽然起搏器治疗血管迷走性晕厥的首个开放标签试验显示出了有前景的结果，但这一效果尚未得到双盲随机临床试验的证实。最新数据似乎表明，40岁以上患有严重心脏停搏性血管迷走性晕厥的患者可能会从永久性起搏器中获益。
