植入型心电监测仪在不明原因晕厥中的临床应用:单中心前瞻性研究  

Clinical application value of insertable cardiac monitor in patients with unexplained syncope:a single-center prospective study

作　　者：陈峰[1] 陈若菡[1] 孙奇[1] 戴研[1] 吴瑛[1] 陈柯萍[1] 张澍[1] Chen Feng;Chen Ruohan;Sun Qi;Dai Yan;Wu Ying;Chen Keping;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardio-vascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,心血管疾病国家重点实验室,阜外医院心律失常中心,北京100037

出　　处：《中华心律失常学杂志》2022年第5期408-411,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨植入型心电监测仪(ICM)在不明原因晕厥中的诊断价值。方法前瞻性观察性研究2017年7月至2021年10月在中国医学科学院阜外医院心律失常中心诊断为不明原因晕厥,并植入ICM的患者45例,其中男29例,女16例。中位年龄52.6岁,年龄范围11~87岁。所有患者每3个月随访1次,随访内容包括是否再次发生晕厥及晕厥前兆事件、ICM程控读取随访期间记录到的事件。若患者出现晕厥,则及早行ICM程控。结果随访(15.0±12.3)个月,15例(15/45,33.3%)患者再发晕厥或晕厥前兆,其中9例为心动过缓导致的(窦性停搏7例,高度房室传导阻滞2例),2例为室性心动过速(室速),1例为心房颤动(房颤),另有3例意识丧失发作时ICM未记录到心律失常事件,后经脑电图证实为癫痫。在心源性晕厥患者中,9例植入永久起搏器,2例选择药物治疗,有1例室速患者发生心脏性猝死。结论ICM可有效提高不明原因晕厥患者的诊断效率。Objective To explore the diagnostic value of insertable cardiac monitor(ICM)in unexplained syncope.Methods A total of 45 patients with unexplained syncope and implanted ICM(29 males and 16 females,mean age 52.6 years,ranging from 11 to 87 years)were enrolled in Center of Arrhythmia,Fuwai Hospital,Chinese Academy of Medical Sciences from July 2017 to October 2021.All patients were followed up every 3 months until the occurrence of syncope or presyncope.Clinical characteristics of syncope or presyncope,and electrocardiograph data recordedby ICM were collected and analyzed.And subjects were advised to contact the treating physician and receive ICM interrogation promptly in the case of a suspected event.Results During the mean follow-up period of(15.0±12.3)months,fifteen patients(15/45.33.3%)had a recurrence of syncope or presyncope.And syncope or presyncope related arrhythmia was confirmed in 12 patients.The ICM records showed sinus node dysfunction in 7 cases,sudden advanced atrioventricular blocks in 2 cases,ventricular tachycardia in 2 cases,atrial fibrillation in 1 case,and no arrhythmic events during the episode in 3 cases,which were confirmed as seizure by electroencephalogram.Among the patients with cardiac syncope,9 patients were implanted with permanent pacemaker implantation,and 2 patients opted for drug therapy.One patient presented with ventricular tachycardia and sudden cardiac death.Conclusion ICM greatly improved the diagnostic efficiency of patients with unexplained syncope.

关 键 词：晕厥 植入型心电监测仪 不明原因晕厥 心动过速 心动过缓 

分 类 号：R54[医药卫生—心血管疾病]