Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Clinical Genetics, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Open Heart. 2021 Aug;8(2). doi: 10.1136/openhrt-2021-001748.
Patients with heart disease are at increased risk for sudden cardiac death. Guidelines recommend an implantable loop recorder (ILR) for symptomatic patients when symptoms are sporadic and possibly arrhythmia-related. In clinical practice, an ILR is mainly used in patients with unexplained syncope. We aimed to compare the clinical value of an ILR in patients with heart disease and a history of syncope versus those with non-syncopal symptoms.
In this observational single-centre study, we included symptomatic patients with heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to device implantation.
One hundred and twenty patients (mean age 47±17 years, 49% men) were included. The underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%) and other (18%). Group A consisted of 43 patients with prior syncope and group B consisted of 77 patients with palpitations and/or near-syncope. The median follow-up duration was 19 months (IQR 8-36). The 3-year cumulative event rate was similar between groups with regard to the primary endpoint (38% vs 39% for group A and B, respectively, logrank p=0.54). There was also no difference in the 3-year cumulative rate of device implantation (21% vs 13% for group A and B, respectively, logrank p=0.65).
In symptomatic patients with heart disease, there is no difference in the yield of an ILR in patients presenting with or without syncope.
患有心脏病的患者发生心源性猝死的风险增加。指南建议对症状呈间歇性且可能与心律失常相关的有症状患者植入植入式循环记录仪（ILR）。在临床实践中，ILR 主要用于不明原因晕厥的患者。我们旨在比较有心脏病和晕厥病史的患者与无晕厥症状的患者中 ILR 的临床价值。
在这项观察性单中心研究中，我们纳入了患有心脏病且接受 ILR 治疗的有症状患者。主要终点是可采取行动的事件，定义为导致临床管理改变的心律失常事件。次要终点是导致设备植入的事件。
共纳入 120 例患者（平均年龄 47±17 岁，49%为男性）。基础疾病包括遗传性心肌病（31%）、先天性心脏病（28%）、通道病（23%）和其他疾病（18%）。A 组有 43 例患者有晕厥病史，B 组有 77 例患者有心悸和/或接近晕厥。中位随访时间为 19 个月（IQR 8-36）。主要终点方面，两组的 3 年累积事件发生率相似（A 组为 38%，B 组为 39%，logrank p=0.54）。3 年设备植入累积率也无差异（A 组为 21%，B 组为 13%，logrank p=0.65）。
在有症状的心脏病患者中，有无晕厥史的患者植入 ILR 的效果无差异。
