Prochnau Dirk, Lambert Tobias, Sigusch Holger, Surber Ralf, Schulze Paul Christian
a Department of Internal Medicine I , Jena University Hospital , Jena , Germany.
b Department of Cardiology , Catholic "St. Johann Nepomuk" Hospital , Erfurt , Germany.
Acta Cardiol. 2017 Oct;72(5):530-535. doi: 10.1080/00015385.2017.1306389. Epub 2017 Jul 6.
The purpose of this study was to examine the usefulness of implantable loop recorders (ILRs) for symptom-rhythm correlation and to identify predictors of future arrhythmic events.
In our dual-centre study, we analysed ILR data of 189 patients (mean age 67.4 ± 15.2 years, 114 male) with unexplained syncope (single syncope 21 patients, recurrent 168 patients, traumatic injury 43 patients). Patients had severe comorbidities such as hypertension (n = 127), coronary artery disease (n = 31), diabetes mellitus (n = 33) and chronic renal insufficiency (n = 18). The median ILR usage was 29 months (M), with a range between 1 and 46 M.
Forty-nine (26%) patients experienced syncope during the study, with a median of 8 M to first recurrence of syncope. In 43 patients, pacemaker implantation was performed because of sinus node disease (n = 29), high-degree AV-block (n = 6) or atrial fibrillation with slow ventricular rate (n = 8). In five patients, an ICD was implanted because of documented ventricular tachycardia (n = 4) or left ventricular ejection fraction <35% (n = 1). One patient received ablation of the cavotricuspid isthmus because of documented atrial flutter. Concerning the clinical course, in five patients explantation of the ILR was necessary due to pocket infection. Three patients died due to non-cardiac causes. Logistic regression analysis revealed that older patients had a significantly higher risk for future arrhythmic events (OR 1.3, p = .039).
ILR monitoring is effective in indicating causes of unexplained syncope by providing symptom-rhythm associations. Only age was a predictor of future arrhythmic events. The mortality in patients with unexplained syncope was very low.
本研究旨在探讨植入式循环记录仪（ILR）在症状与节律相关性方面的实用性，并确定未来心律失常事件的预测因素。
在我们的双中心研究中，我们分析了189例病因不明的晕厥患者（平均年龄67.4±15.2岁，男性114例）的ILR数据。这些患者包括单次晕厥21例、反复晕厥168例、外伤43例。患者患有严重的合并症，如高血压（n = 127）、冠状动脉疾病（n = 31）、糖尿病（n = 33）和慢性肾功能不全（n = 18）。ILR的中位使用时间为29个月（M），范围在1至46 M之间。
49例（26%）患者在研究期间发生晕厥，首次晕厥复发的中位时间为8 M。43例患者因窦房结疾病（n = 29）、高度房室传导阻滞（n = 6）或伴有缓慢心室率的心房颤动（n = 8）而进行了起搏器植入。5例患者因记录到室性心动过速（n = 4）或左心室射血分数<35%（n = 1）而植入了植入式心脏除颤器（ICD）。1例患者因记录到心房扑动而接受了三尖瓣峡部消融。关于临床过程，5例患者因囊袋感染而需要取出ILR。3例患者因非心脏原因死亡。逻辑回归分析显示，老年患者未来发生心律失常事件的风险显著更高（比值比1.3，p = 0.039）。
ILR监测通过提供症状与节律的关联，有效地指明了病因不明的晕厥原因。只有年龄是未来心律失常事件的预测因素。病因不明的晕厥患者死亡率非常低。
