Tanno Kaoru
Cardiovascular Division, Showa University Koto-Toyosu Hospital, 5-1-38 Toyosu Koto-Ku, Tokyo 135-8577, Japan.
J Arrhythm. 2017 Dec;33(6):579-582. doi: 10.1016/j.joa.2017.03.006. Epub 2017 May 11.
The gold standard for diagnosing syncope is to elucidate the symptom-electrocardiogram (ECG) correlation. The ECG recordings during syncope allow physicians to either confirm or exclude an arrhythmia as the mechanism of syncope. Many studies have investigated the use of internal loop recorder (ILR), while few studies have used external loop recorder (ELR) for patients with unexplained syncope. The aim of this review is to clarify the clinical usefulness of ILR and ELR in the diagnosis and management of patients with unexplained syncope. Many observational and four randomized control studies have shown that ILR for patients with unknown syncope is a useful tool for early diagnosis and improving diagnosis rate. ILR also provides important information on the mechanism of syncope and treatment strategy. However, there is no evidence of total mortality or quality of life improvements with ILR. The diagnostic yield of ELR in patients with syncope was similar to that with ILR within the same timeframe. Therefore, ELR could be considered for long-term ECG monitoring before a patient switches to using ILR. A systematic approach and selection of ECG monitoring tools reduces health care costs and improves the selection of patients for optimal treatment possibilities.
诊断晕厥的金标准是阐明症状与心电图（ECG）的相关性。晕厥期间的心电图记录使医生能够确认或排除心律失常作为晕厥的机制。许多研究探讨了植入式循环记录仪（ILR）的应用，而针对不明原因晕厥患者使用外置式循环记录仪（ELR）的研究较少。本综述的目的是阐明ILR和ELR在不明原因晕厥患者诊断和管理中的临床实用性。许多观察性研究和四项随机对照研究表明，对于不明原因晕厥患者，ILR是早期诊断和提高诊断率的有用工具。ILR还提供了关于晕厥机制和治疗策略的重要信息。然而，没有证据表明ILR能提高总生存率或改善生活质量。在同一时间段内，ELR对晕厥患者的诊断率与ILR相似。因此，在患者改用ILR之前，可考虑使用ELR进行长期心电图监测。采用系统方法并选择心电图监测工具可降低医疗成本，并改善患者的最佳治疗选择。
