植入型心电监测仪在中国云南部分地区的临床应用  

Clinical application of insertable cardiac monitor in selected regions of Yunnan,China

作　　者：李国春 郭任 孙彪 邹洪[4] 李燕萍[2] 刘宏 杨景峰 郭涛 郝应禄[2] 吴新华 郭雨龙 Li Guochun;Guo Ren;Sun Biao;Zou Hon;Li Yanping;Liu Hong;Yang Jingfeng;Guo Tao;Hao Yinglu;Wu Xinhua;Guo Yulong(Department of Arrhythmia,Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences,Kunming 650102,China;Department of Cardiology,Yuxi People's Hospital,Yuxi 653100,China;Department of Cardiology,The First Affliated Hospital of Dali University,Dali 671000,China;Department of Cardiology,Baoshan People's Hospital,Baoshan 678000,China;Graduate School of Kunming Medical University,Kunming 650500,China)

机构地区：[1]云南省阜外心血管病医院心律失常中心,昆明650102 [2]玉溪市人民医院心内科,玉溪653100 [3]大理大学第一附属医院心内科,大理671000 [4]保山市人民医院心内科,保山678000 [5]昆明医科大学研究生院,昆明650500

出　　处：《中华心律失常学杂志》2024年第5期428-433,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：云南省科技厅-昆明医科大学应用基础研究联合基金面上项目(202301AY070001-043);云南省心血管病临床医学中心项目(FZX2019-06-01)。

摘　　要：目的植入型心电监测仪(ICM)在我国云南部分地区的临床应用情况。方法本研究为前瞻性观察性研究。连续入组云南昆明、玉溪、大理、保山4家中心植入ICM的患者,收集基线相关临床资料,植入后进行常规随访及事件驱动随访,收集记录心电数据及后续诊疗措施。结果纳入146例患者,其中男105例(71.9%,105/146),年龄(55.6±15.8)岁,年龄范围9~89岁。植入ICM原因涵盖心房颤动(房颤)消融术后监测、不明原因晕厥、心悸及隐源性卒中检查。植入术后即刻R波振幅(0.985±0.532)mV,随访期间2例出现囊袋并发症,9例退出,137例完成随访,中位随访时间394.0(288.5,478.5)d。心房颤动(房颤)消融术后患者中,末次消融术后6、9、12个月的累计复发率分别为39.5%、51.2%、65.1%。不明原因晕厥患者中,明确诊断27例(39.1%,27/69),24例(88.9%,24/27)诊断为心源性晕厥,其中病态窦房结综合征占比最高(55.6%,15/27)。不明原因心悸患者中,明确诊断22例(62.9%,22/35)。结论ICM植入操作简便,患者创伤小,不良反应发生率低。ICM可以加强房颤导管消融术后的监测并指导治疗,提高不明原因晕厥和心悸患者心律失常的诊断效率,具有临床实用价值。Objective To investigate the clinical application of insertable cardiac monitor(ICM)in selected regions of Yunnan Province.Methods This was a prospective observational study.This study was a multicenter prospective observational investigation that involved patients who underwent ICM implantation in four medical centers in Kunming,Yuxi,Dali,and Baoshan,Yunnan Province were successively enrolled.Baseline clinical data were collected in a systematic manner.Enrolled patients received both routine and event-driven follow-up assessments after ICM implantation.Electrocardiographic data and documented subsequent clinical diagnosis and treatment measures were recorede rigorously.Results A total of 146 patients were included,with 105 males(71.9%,105/146);age was(55.6±15.8)years(range 9-89 years).The reasons for ICM implantation included post-atrial fibrillation ablation monitoring,unexplained syncope,palpitations,and cryptogenic stroke evaluation.Immediate post-implant R-wave amplitude was(0.985±0.532)mV.During follow-up,2 patients developed pocket complications,9 cases withdrew,and 137cases completed follow-up with a median duration of 394.0(288.5,478.5)days.Among patients with post-atrial fibrillation ablation,cumulative recurrence rates at 6,9,and 12 months were 39.5%,51.2%,and 65.1%,respectively.In patients with unexplained syncope,27 cases(39.1%,27/69)were diagnosed,and 24 cases(88.9%,24/27)were diagnosed as cardiogenic syncope,most commonly sick sinus syndrome,which accounted for 15 cases(55.6%,15/27).Among patients with unexplained palpitations,22 cases(62.9%,22/35)received a definitive diagnosis.ConclusionICM implantation is a straightforward and low-risk procedure that significantly strengthens post-atrial fibrillation ablation monitoring and treatment guidance.It also enhances the diagnostic accuracy of arrhythmias in individuals with unexplained syncope and palpitations,highlighting its clear clinical utility.

关 键 词：心房颤动 植入型心电监测仪 导管消融术 晕厥 心悸 诊断效率 

分 类 号：R541.75[医药卫生—心血管疾病]