Dodeja Anudeep K, Thomas Courtney, Daniels Curt J, Kertesz Naomi, Kamp Anna
Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Congenit Heart Dis. 2019 Sep;14(5):745-751. doi: 10.1111/chd.12815. Epub 2019 Jul 16.
Rhythm disorders are the leading cause of morbidity and mortality in adults with congenital heart disease (ACHD). Infrequent or asymptomatic arrhythmias may not be detected by routine monitoring. Implantable loop recorders (ILRs), such as the Reveal LINQ , have been useful in long-term monitoring for arrhythmias in adults with cryptogenic stroke.
We propose the Reveal LINQ will detect arrhythmias, not documented by other monitoring modalities, resulting in change in management in ACHD patients.
This is a single center retrospective review of Reveal LINQ use in ACHD patients from 2014-2017. Medical records were reviewed to determine cardiac diagnosis, indication for implant, ILR findings, and changes in management.
Twenty-two patients, median age 25 years, underwent ILR implantation. ILR findings resulted in change in management in nine (41%) patients. One-third (3/9) of the patients with clinically relevant events were asymptomatic. Patients with Fontan palliation had the highest number of pertinent positive events (57%). ACHD physiologic class D patients were more likely to have a positive finding (P = .034) compared to other physiologic classes. Majority (75%) of patients with positive events had arrhythmias documented on ILR which were not demonstrated on prior Holter/event monitors. Pertinent negative event occurred in one patient with Fontan palliation (5%) who had syncope corresponding to sinus rhythm.
ILRs are a useful adjunct for arrhythmia monitoring in the ACHD population with clinically relevant events in 41% of patients. A special consideration for ILRs could be made for high-risk asymptomatic patients.
心律失常是成人先天性心脏病（ACHD）患者发病和死亡的主要原因。常规监测可能无法检测到不常见或无症状的心律失常。植入式循环记录仪（ILR），如Reveal LINQ，已被用于对不明原因卒中的成人患者进行心律失常的长期监测。
我们认为Reveal LINQ将检测到其他监测方式未记录的心律失常，从而导致ACHD患者的治疗方案改变。
这是一项对2014年至2017年期间在ACHD患者中使用Reveal LINQ的单中心回顾性研究。回顾病历以确定心脏诊断、植入指征、ILR检查结果和治疗方案的改变。
22例患者（中位年龄25岁）接受了ILR植入。ILR检查结果导致9例（41%）患者的治疗方案改变。三分之一（3/9）有临床相关事件的患者无症状。接受Fontan姑息手术的患者相关阳性事件数量最多（57%）。与其他生理分级的患者相比，ACHD生理分级为D级的患者更有可能有阳性发现（P = 0.034）。多数（75%）有阳性事件的患者在ILR上记录到心律失常，而之前的动态心电图/事件监测仪未显示。一名接受Fontan姑息手术的患者（5%）发生了相关阴性事件，其晕厥发作时为窦性心律。
ILR是ACHD人群心律失常监测的有用辅助手段，41%的患者有临床相关事件。对于高危无症状患者，可特别考虑使用ILR。
