置入式Holter诊断不明原因晕厥的应用研究

目的探讨置入式Holter(ILR)在诊断不明原因晕厥和指导治疗中的临床价值。方法入选2002年10月至2005年5月求治的不明原因晕厥患者10例,男性4例,女性6例,平均年龄(41±22)岁。有2次以上晕厥或近似晕厥史平均为(4.5±1.4)次/例,经常规检查未能明确晕厥原因。均选用Medtronic公司RevealPlus(9526型ILR。结果10例患者平均随访(17.8±6.6)个月,ILR有效监测时间平均(15.3±3.6)个月,监测期内6例患者再发晕厥或近似晕厥24次。7例患者手动触发19段心电图,ILR自动触发记录460段心电图,共记录211段心电图为心律失常事件。根据症状-心律相关性,7例患者明确为心律失常性晕厥,1例患者明确为非心律失常性晕厥;2例仍不能明确晕厥原因。提示ILR诊断晕厥的效率为80%。10例依据ILR监测结果得到相应治疗,晕厥发作减少或消失。结论ILR用于诊断不明原因晕厥和先兆晕厥安全、高效、长程,可证实或排除患者的部分晕厥或近似晕厥系心律失常所致;具有微创、简单、监测期长、信息量大等优点,可作为现有晕厥诊断方法的重要补充。加强患者的依从性和动态优化工作参数,将进一步提高ILR的诊断价值。

Efficacy of implantable loop recorders in establishing symptom-rhythm correlation in patients with unexplained syncope

OBJECTIVE: To evaluate the efficacy of the implantable loop recorder (ILR) in establishing symptom-rhythm correlation in patients with unexplained syncope. METHODS: Implantable loop recorders (ILR, Reveal Plus(9526), Medtronic Inc.) were implanted in 10 patients aged 14 - 78 (41 +/- 22) years, 6 female] with unexplained syncope from October 2002 to May 2005. Syncopal episodes were (4.5 +/- 1.4) patients. RESULTS: During the monitoring period 8 - 21 (15.3 +/- 3.6) months], there were 24 times syncopal episodes in 6 patients. A total of 211 arrhythmia events were documented by ILR in 7 patients and symptom-rhythm correlation could be established in these 7 patients. In 2 patients, there were no recurrent syncopes and no arrhythmia events could be recorded. In 1 patient, syncope was caused by reasons other than arrhythmia. CONCLUSION: ILR is useful in determining the presence or absence of an arrhythmia during symptoms of syncope when conventional diagnostic testing, such as electrocardiogram, Holter monitoring, and/or external loop recording, is inconclusive.