接受ICM的不明原因晕厥患者需行起搏治疗的临床预测因素分析  

Identifying predictive factors for pacemaker implantation in patients with unexplained syncope receiving implantable cardiac monitor

作　　者：孙志军[1] 梁立丰 柳晓娜 杨汪洋 邸北冰[1] 张妮潇 彭晖[1] Sun Zhijun;Lian Lifengg;Liu Xiaona;Yan Wangyang;Di Beibing;Zhang Nixiao;Peng Hui(Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Cardiology,Second People's Hospital of Hengshui,Hengshui 053000,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 [2]衡水市第二人民医院心内科,河北衡水053000

出　　处：《中华脑血管病杂志（电子版）》2024年第5期446-453,共8页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

摘　　要：目的回顾性分析不明原因晕厥患者在接受植入式心电监测仪(ICM)后需要进行起搏治疗的预测因素,旨在为ICM在此类高风险患者中的早期临床应用,以及有效的起搏治疗提供更多的依据。方法连续纳入2019年12月至2022年6月首都医科大学附属北京友谊医院因不明原因晕厥住院并接受ICM植入的患者127例。其中,通过ICM监测到缓慢性心律失常并符合永久起搏器(PPM)植入指征的患者52例(PPM指征组),未监测到缓慢性心律失常的患者75例(非PPM指征组)。2组患者均随访至2024年6月,期间记录晕厥/晕厥前兆相关事件并进行病因分析及相应治疗;同时评价ICM诊断的缓慢性心律失常需植入PPM的预测因素。结果PPM指征组患者年龄更大(P=0.030),最低心率更慢(P<0.001),更多的患者停搏>2 s(P<0.001);Ⅰ度房室传导阻滞(AVB)、Ⅰ度AVB合并右束支传导阻滞(RBBB)或合并左束支传导阻滞(LBBB)更为常见(分别为P<0.001、P=0.039、P=0.016)。多因素分析显示,HOLTER监测到的最低心率(P=0.024)、PR间期(P<0.001)、停搏>2 s(P<0.001)是ICM诊断的缓慢性心律失常需植入PPM的独立预测因子;且受试者工作特征曲线的曲线下面积显示,3个因子联合预测的价值更高(AUC=0.840,95%CI:0.770~0.909)。结论HOLTER监测到的最低心率、PR间期、停搏>2 s是预测ICM指导PPM植入的高风险因素,给予此类高风险的不明原因晕厥患者早期植入ICM可能获益更大。Objective To bolster the evidence for the early clinical application of implantable cardiac monitors(ICM)in high-risk patients and to optimize effective pacemaker therapy,by retrospectively analyzing the predictors for the need for pacemaker therapy in patients with unexplained syncope who underwent implantation of an ICM.Methods A total of 127 patients hospitalized for unexplained syncope and received ICM implantation at Beijing Friendship Hospital,Capital Medical University,between December 2019 and June 2022,were consecutively enrolled.Among them,52 patients diagnosed with bradyarrhythmias through ICM monitoring met the criteria for permanent pacemaker(PPM)implantation(PPM indication group),while 75 patients did not exhibit bradyarrhythmias(non-PPM indication group).Both groups were followed up until June 2024.During the follow-up,syncope/presyncope-related events were recorded,and etiological analysis and corresponding treatments were conducted.Predictors for the need for PPM implantation due to bradyarrhythmias detected by ICM were also evaluated.Results Patients in the PPM indication group were older(P=0.030)and had a slower minimum heart rate(P<0.001),with a higher incidence of pauses exceeding 2 seconds(P<0.001).First-degree atrioventricular block(AVB),firstdegree AVB combined with right bundle branch block(RBBB),or left bundle branch block(LBBB)were more common in this group(P<0.001,P=0.039,and P=0.016,respectively).Multivariate analysis identified the minimum heart rate(P=0.024),PR interval(P<0.001),and pauses>2 seconds(P<0.001)detected by HOLTER monitoring as independent predictors of the need for PPM implantation due to bradyarrhythmias diagnosed by ICM.Moreover,the area under curve(AUC)of the receiver operating characteristic curve for the combined predictive value of these three factors was higher(AUC=0.840,95%CI:0.770-0.909).Conclusion The minimum heart rate,PR interval,and pauses>2 seconds detected by HOLTER monitoring are significant risk factors for predicting the need for PPM implantation guide

关 键 词：不明原因晕厥 植入式心电监测仪 永久起搏器 预测因素 

分 类 号：R741[医药卫生—神经病学与精神病学]