The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
Heart Rhythm. 2024 Sep;21(9):1703-1710. doi: 10.1016/j.hrthm.2024.03.038. Epub 2024 Mar 18.
Implantable loop recorders (ILRs) are increasingly used to evaluate patients with unexplained syncope. Identification of all predictors of bradycardic syncope and consequent permanent pacemaker (PPM) insertion is of substantial clinical interest as patients in the highest risk category may benefit from upfront pacemaker insertion.
We performed a systematic review and meta-analysis to identify risk predictors for PPM insertion in ILR recipients with unexplained syncope.
An electronic database search (MEDLINE, Embase, Scopus, Cochrane) was performed in June 2023. Studies evaluating ILR recipients with unexplained syncope and recording risk factors for eventual PPM insertion were included. A random effects model was used to calculate the pooled odds ratio (OR) for clinical and electrocardiographic characteristics with respect to future PPM requirement.
Eight studies evaluating 1007 ILR recipients were included; 268 patients (26.6%) underwent PPM insertion during study follow-up. PPM recipients were older (mean age, 70.2 ± 15.4 years vs 61.6 ± 19.7 years; P < .001). PR prolongation on baseline electrocardiography was a significant predictor of PPM requirement (pooled OR, 2.91; 95% confidence interval, 1.63-5.20). The presence of distal conduction system disease, encompassing any bundle branch or fascicular block, yielded a pooled OR of 2.88 for PPM insertion (95% confidence interval, 1.53-5.41). Injurious syncope and lack of syncopal prodrome were not significant predictors of PPM insertion. Sinus node dysfunction accounted for 62% of PPM insertions, whereas atrioventricular block accounted for 26%.
Approximately one-quarter of ILR recipients for unexplained syncope require eventual PPM insertion. Advancing age, PR prolongation, and distal conduction disease are the strongest predictors for PPM requirement.
植入式循环记录器（ILR）越来越多地用于评估不明原因晕厥的患者。确定所有导致缓慢性晕厥和随后永久性起搏器（PPM）植入的预测因素具有重要的临床意义，因为风险最高的患者可能受益于早期起搏器植入。
我们进行了系统回顾和荟萃分析，以确定不明原因晕厥的 ILR 受者中 PPM 植入的风险预测因素。
2023 年 6 月进行了电子数据库搜索（MEDLINE、Embase、Scopus、Cochrane）。评估不明原因晕厥且记录最终 PPM 植入风险因素的 ILR 受者的研究被纳入。使用随机效应模型计算与未来 PPM 需求相关的临床和心电图特征的汇总优势比（OR）。
纳入了 8 项评估 1007 例 ILR 受者的研究；268 例患者（26.6%）在研究随访期间植入了 PPM。PPM 植入组患者年龄较大（平均年龄，70.2±15.4 岁 vs 61.6±19.7 岁；P<0.001）。基线心电图 PR 延长是 PPM 需求的显著预测因素（汇总 OR，2.91；95%置信区间，1.63-5.20）。存在远端传导系统疾病，包括任何束支或分支阻滞，汇总 OR 为 2.88 用于 PPM 植入（95%置信区间，1.53-5.41）。创伤性晕厥和无晕厥前驱症状不是 PPM 植入的显著预测因素。窦房结功能障碍占 PPM 植入的 62%，而房室传导阻滞占 26%。
大约四分之一不明原因晕厥的 ILR 受者需要最终植入 PPM。年龄增长、PR 延长和远端传导疾病是 PPM 需求的最强预测因素。
