Ibrahim Omar A, Drew Doran, Hayes Christopher J, McIntyre William, Seifer Colette M, Hopman Wilma, Glover Benedict, Baranchuk Adrian M
Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Department of Cardiology, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
J Interv Card Electrophysiol. 2017 Nov;50(2):179-185. doi: 10.1007/s10840-017-0294-y. Epub 2017 Nov 2.
Implantable loop recorders (ILRs) are increasingly being used for ambulatory electrocardiography. We sought to evaluate ILR indications, diagnostic yield, ILR-guided interventions, and complications in two Canadian centers.
This was a retrospective study using electronic medical records to identify ILR implants at Queen's University and the University of Manitoba. Information was collected on patient characteristics, medications, indication for implant, results of prior investigations, diagnostic outcome, and subsequent management.
A total of 540 patients were identified; 386 had completed monitoring at time of analysis. Forty patients were lost to follow-up. Indications were unexplained syncope 84.8%, palpitations 12.8%, and suspected atrial fibrillation 11.7%. For syncope, ILRs documented arrhythmia or conduction disorder in 46%. Most common conditions were asystole/sinus pause (22%), complete heart block (10.4%), and atrial fibrillation (AF) (6.9%). After ILR diagnosis, 39.9% of implanted patients received pacemaker/ICD and 2.7% underwent catheter ablation. For palpitations, ILRs documented arrhythmia or conduction disorder in 60.4%. Most common conditions were AVNRT, AF, complete heart block, and ventricular tachycardia. After diagnosis, 25% underwent catheter ablation and 22.9% received pacemaker/ICD. For suspected AF, AF was diagnosed in 40%. Complications were observed in 3.3% of implanted patients: implant site infection 1.5%, non-infectious implant site pain requiring device removal or pocket revision 1.5%, 0.2% hypertrophic scar, and 0.2% device malfunction.
An ILR has excellent diagnostic yield for syncope, palpitations, and suspected AF, and a considerable proportion of patients undergo ILR-directed interventions following monitoring. ILR implantation is a low-risk procedure.
植入式循环记录仪（ILR）越来越多地用于动态心电图检查。我们试图评估加拿大两个中心的ILR适应证、诊断率、ILR引导下的干预措施及并发症。
这是一项回顾性研究，利用电子病历识别女王大学和曼尼托巴大学的ILR植入情况。收集了患者特征、用药情况、植入适应证、既往检查结果、诊断结果及后续治疗等信息。
共识别出540例患者；分析时386例已完成监测。40例失访。适应证包括不明原因晕厥84.8%、心悸12.8%、疑似心房颤动11.7%。对于晕厥患者，ILR记录到心律失常或传导障碍的比例为46%。最常见的情况是心脏停搏/窦性停搏（22%）、完全性心脏传导阻滞（10.4%）和心房颤动（AF）（6.9%）。ILR诊断后，39.9%的植入患者接受了起搏器/植入式心脏复律除颤器（ICD）治疗，2.7%接受了导管消融治疗。对于心悸患者，ILR记录到心律失常或传导障碍的比例为60.4%。最常见的情况是房室结折返性心动过速、AF、完全性心脏传导阻滞和室性心动过速。诊断后，25%接受了导管消融治疗，22.9%接受了起搏器/ICD治疗。对于疑似AF患者，AF确诊率为40%。3.3%的植入患者出现并发症：植入部位感染1.5%、非感染性植入部位疼痛需取出装置或修整囊袋1.5%、肥厚性瘢痕0.2%、装置故障0.2%。
ILR对晕厥、心悸和疑似AF具有出色的诊断率，相当一部分患者在监测后接受了ILR指导的干预措施。ILR植入是一种低风险手术。
