回顾性分析植入型心电监测仪在不明原因晕厥患者中的诊断价值  

Retrospective analysis of the diagnostic value of insertable cardiac monitor in patients with unexplained syncope

作　　者：孙志军[1] 杨汪洋 邸北冰[1] 公绪合 张妮潇 杨延坤 彭晖[1] Sun Zhijun;Yang Wangyang;Di Beibing;Gong Xuhe;Zhang Nixiao;Yang Yankun;Peng Hui(Department of Cardiology,Cardiovascular Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院心内科,北京100050

出　　处：《中华心律失常学杂志》2022年第5期412-417,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨植入型心电监测仪(ICM)对不明原因晕厥的临床诊断价值,为ICM临床应用提供更多依据。方法连续入选2020年1月至2022年2月在首都医科大学附属北京友谊医院因不明原因晕厥住院的患者168例。植入ICM患者76例(ICM植入组),其中男40例(52.6%,40/76),年龄(62.1±14.4)岁;同期因不明原因晕厥住院经晕厥相关的系统性检查且未植入ICM患者92例(ICM未植入组),其中男60例(65.2%,60/92),年龄(63.8±11.9)岁。两组患者均随访至2022年7月,记录晕厥事件并分析病因,采取相应治疗。结果ICM未植入组发生晕厥或晕厥前兆事件并明确病因者1例,确诊率为1.1%(1/92);ICM植入组发生晕厥或晕厥前兆事件并明确病因者共30例,确诊率为39.5%(30/76),明显高于ICM未植入组患者(39.5%对1.1%,P<0.001)。22例(28.9%,22/76)患者因ICM监测结果而改变了治疗策略:13例(17.1%,13/76)患者植入永久起搏器,2例(2.6%,2/76)患者接受射频消融,分别有2例(2.6%,2/76)和4例(5.3%,4/76)患者开始抗凝或抗心律失常药物治疗,1例(1.3%,1/76)非心律失常病因患者接受抗癫痫治疗。结论不明原因晕厥患者植入ICM后可以显著提高晕厥病因的诊断率,尤其对反复晕厥患者有助于排除心脏性晕厥,因此对于不明原因晕厥患者建议尽早植入ICM,及时得到精准治疗。Objective To investigate the diagnostic value of insertable cardiac monitor(ICM)in patients with unexplained syncope in order to provide more evidence for the clinical application of ICM.Methods Consecutively enrolled patients due to unexplained syncope who were hospitalized in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2020 to February 2022 were analyzed.Among them,76 patients[52.6%male,mean age(62.1±14.4)years]received ICMs for syncope indication(ICM implantation group);92 patients[65.2%male,mean age(63.8±11.9)years]did not underwent ICM implantation after systematic examination related to syncope(non-ICM implantation group).Patients in both groups were followed up to July 2022.During follow-up,syncope events were recorded.And we analyzed symptom rhythm correlation through ICM monitoring,which resulted in a management decision or change being enacted.Results In non-ICM implantation group,one patient had syncope or pre-syncope and the etiology was confirmed.Diagnosis yield was 1.1%(1/92).In ICM implantation group,30 patients had syncope or pre-syncope and the etiology was identified.Definite diagnosis yield was 39.5%(30/76)which was much higher than that in non-ICM implantation group(39.5%vs 1.1%,P<0.001).Twenty-two(28.9%)patients had a change in management due to results of ICM monitoring.A pacemaker implant was pursued in 13(13/76,17.1%)patients.Four(4/76,5.3%)patients received radiofrequency ablation.Anticoagulant therapy or antiarrhythmic medications was started in 2(2/76,7.5%)and 4(4/76,8.2%)patients respectively.Antiepileptic therapy was pursued in 1(1/76,1.3%)patient with non-arrhythmic etiology.Conclusion ICM implantation in patients with unexplained syncope can significantly improve the diagnosis yield of syncope etiology.Especially,it is helpful to exclude cardiogenic syncope.Therefore,for patients with unexplained syncope,it is recommended to implant ICM as soon as possible,which leads to changes in patient management in time.

关 键 词：晕厥 植入型心电监测仪 不明原因 

分 类 号：R654.2[医药卫生—外科学]