Silveira Inês, Sousa Maria João, Antunes Nuno, Silva Vânia, Roque Carla, Pinheiro-Vieira António, Lagarto Vítor, Hipólito-Reis António, Luz André, Torres Severo
Pacing and electrophysiology Department, Centro Hospitalar do Porto, Portugal.
J Atr Fibrillation. 2016 Aug 31;9(2):1425. doi: 10.4022/jafib.1425. eCollection 2016 Aug-Sep.
Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. A total of 62 patients were included, 50% men, with a mean age of 62.5±18.8 years old. Previously to ILR implantation 88.7% of patients had performed Holter, 17.7% external events recorder, 33.9% Tilt test and 29% an electrophysiological study. The implantation indications were recurrent syncope in 90.3%, palpitations 8.1% and ischemic stroke in one patient. Mean follow-up time was 17.1±16.3 months. Symptoms were reported in 66.1% of the patients, 46.8% of those yielding a diagnostic finding. In all cases of palpitation complaints with diagnosis we found atrial fibrillation (AF). In patients with syncope atrioventricular conduction disturbance was demonstrated in 19.6%, sinus node dysfunction in 16.1%, paroxysmal supra-ventricular tachycardia 7.1% and AF in 1.8%. These finding resulted in 19 pacemaker and one CRT-D implantation, introduction of anticoagulation in five patients and one ablation of accessory pathway. There were no major complications. ILR proved to be safe and efficient. It has enabled the identification or exclusion of serious rhythm disturbances in more than half of patients and provided a targeted therapeutic intervention.
晕厥或心悸等症状常常带来诊断挑战。植入式循环记录仪（ILR）是管理这些患者的重要辅助手段。对2007年11月至2014年接受ILR植入的患者进行了一项回顾性研究。评估了每位患者的植入指征、基线特征、既往检查、并发症、记录的心电图及干预措施。共纳入62例患者，其中男性占50%，平均年龄为62.5±18.8岁。在植入ILR之前，88.7%的患者进行了动态心电图检查，17.7%的患者使用了体外事件记录仪，33.9%的患者进行了直立倾斜试验，29%的患者进行了电生理检查。植入指征为复发性晕厥的患者占90.3%，心悸的患者占8.1%，另有1例患者为缺血性卒中。平均随访时间为17.1±16.3个月。66.1%的患者报告有症状，其中46.8%的患者有诊断性发现。在所有诊断为心悸的病例中，均发现心房颤动（AF）。在晕厥患者中，19.6%表现为房室传导障碍，16.1%为窦房结功能障碍，7.1%为阵发性室上性心动过速，1.8%为AF。这些发现导致19例患者植入起搏器，1例患者植入心脏再同步化治疗除颤器（CRT-D），5例患者开始抗凝治疗，1例患者进行了旁路消融。无重大并发症。ILR被证明是安全有效的。它使超过一半的患者能够识别或排除严重的心律失常，并提供了有针对性的治疗干预。
