电生理检查在老年晕厥合并心脏病患者中的应用价值是什么？

What is The Utility of Electrophysiological Study in Elderly Patients with Syncope and Heart Disease?

作者信息

Aslam Rumas, Girerd Nicolas, Brembilla-Perrot Beatrice

机构信息

Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.

INSERM, Centre d'Investigations Cliniques 9501, Universite de Lorraine, Institut Lorrain du cour et des vaisseaux, CHU de Nancy, Nancy, France.

出版信息

Indian Pacing Electrophysiol J. 2015 Apr 1;15(1):32-42. doi: 10.1016/s0972-6292(16)30840-3. eCollection 2015 Jan-Feb.

DOI:10.1016/s0972-6292(16)30840-3

PMID:25852241

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4380693/

Abstract

BACKGROUND

Syncope in elderly patients with heart disease is a growing problem. Its aetiological diagnosis is often difficult. We intended to investigate the value of the electrophysiological study (EPS) in old patients with syncope and heart disease.

METHODS

EPS was performed in 182 consecutive patients with syncope and heart disease, among whom 62 patients were ≥75 years old and 120 patients <75.

RESULTS

Left ventricular ejection fraction was 43.9±11.7% in patients ≥75 and 41.1±12.6% in patients <75. During EPS, induced sustained ventricular arrhythmias were as frequent in both groups (27.4% in patients ≥75 versus 27.5% in patients <75, p=0.99) whereas AV conduction abnormalities were more frequent in older patients (37.1% in patients ≥75 versus 18.3% in patients <75, p<0.005). Syncope remained unexplained in 35.5% of patients ≥75 and in 51.7% of patients <75 (p>0.04). ICD was more likely to be implanted in younger patients than in patients ≥75 years (37.5% vs 21% respectively, p<0.009). During a mean follow-up period of 3.3±3 years, the 4-year-survival rate was 66.9±6.8 % in patients ≥75 and 75.9±6.2 % in patients <75 years. The main cause of death was heart failure in both groups. The factors related to a worse outcome in a multivariate analysis were low LVEF and higher age.

CONCLUSION

Complete EPS allows the identification of treatable causes in a high proportion of elderly patients with syncope and heart disease. Yet, the prognosis of these patients is mainly related to LVEF and age.

摘要

背景

老年心脏病患者的晕厥问题日益严重。其病因诊断往往困难。我们旨在研究电生理检查（EPS）在老年晕厥合并心脏病患者中的价值。

方法

对182例连续的晕厥合并心脏病患者进行了EPS检查，其中62例患者年龄≥75岁，120例患者年龄<75岁。

结果

年龄≥75岁患者的左心室射血分数为43.9±11.7%，年龄<75岁患者为41.1±12.6%。在EPS检查期间，两组诱发持续性室性心律失常的频率相似（年龄≥75岁患者为27.4%，年龄<75岁患者为27.5%，p=0.99），而老年患者房室传导异常更为常见（年龄≥75岁患者为37.1%，年龄<75岁患者为18.3%，p<0.005）。年龄≥75岁患者中35.5%和年龄<75岁患者中51.7%的晕厥原因仍未明确（p>0.04）。年龄<75岁的患者比年龄≥75岁的患者更有可能植入植入式心脏复律除颤器（ICD）（分别为37.5%和21%，p<0.009）。在平均3.3±3年的随访期内，年龄≥75岁患者的4年生存率为66.9±6.8%，年龄<75岁患者为75.9±6.2%。两组的主要死亡原因均为心力衰竭。多因素分析中与预后较差相关的因素是低左心室射血分数和高龄。