Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope
Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope
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DOI：
10.1093/eurheartj/ehi842
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发表时间：
2006-05-01
影响因子：
39.3
通讯作者：
Vardas, P
中科院分区：
文献类型：
--
作者：
Brignole, M;Sutton, R;Vardas, P
目的：本前瞻性多中心观察研究评估了基于植入式环路记录仪（ILR）诊断观察的特异性治疗对复发性疑似神经介导性晕厥（NMS）患者的疗效。方法和结果纳入近2年内3次及以上临床严重晕厥发作且无明显心电图和心脏异常的患者。排除直立性低血压和颈动脉窦性晕厥。ILR植入后，对患者进行随访，直到首次记录晕厥（I期）。该发作的ILR记录决定了随后的治疗并开始了II期随访。在392例患者中，I期1年晕厥复发率为33%。103例患者有记录发作并进入II期：53例患者接受了特异性治疗[47例患者因心脏骤停持续时间中位数为11.5 s而使用起搏器，6例患者接受了抗心动过速治疗（导管消融4例，植入式除颤器1例，抗心律失常药物1例）]，其余50例患者未接受特异性治疗。53例接受特异性治疗的患者的1年复发率为10%（负担0.07 +/- 0.2次/患者/年），而未接受特异性治疗的患者的1年复发率为41%（负担0.83 +/- 1.57次/患者/年）（患者相对风险降低80%，P=0.002，负担降低92%，P=0.002）。起搏器患者1年复发率为5%（负担0.05 +/- 0.15次/患者/年）。继发于晕厥复发的严重创伤占2%，轻度创伤占4%。结论：基于早期诊断ILR应用的策略，延迟治疗直到晕厥证明，可以为NMS患者提供安全，特异性和有效的治疗。
Aims This prospective multicentre observational study assessed the efficacy of specific therapy based on implantable loop recorder (ILR) diagnostic observations in patients with recurrent suspected neurally mediated syncope (NMS).Methods and results Patients with three or more clinically severe syncopal episodes in the last 2 years without significant electrocardiographic and cardiac abnormalities were included. Orthostatic hypotension and carotid sinus syncope were excluded. After ILR implantation, patients were followed until the first documented syncope (Phase I). The ILR documentation of this episode determined the subsequent therapy and commenced Phase II follow-up. Among 392 patients, the 1-year recurrence rate of syncope during Phase I was 33%. One hundred and three patients had a documented episode and entered Phase II: 53 patients received specific therapy [47 a pacemaker because of asystole of a median 11.5 s duration and six anti-tachyarrhythmia therapy (catheter ablation: four, implantable defibrillator: one, anti-arrhythmic drug: one)] and the remaining 50 patients did not receive specific therapy. The 1-year recurrence rate in 53 patients assigned to a specific therapy was 10% (burden 0.07 +/- 0.2 episodes per patient/year) compared with 41% (burden 0.83 +/- 1.57 episodes per patient/year) in the patients without specific therapy (80% relative risk reduction for patients, P=0.002, and 92% for burden, P=0.002). The 1-year recurrence rate in patients with pacemakers was 5% (burden 0.05 +/- 0.15 episodes per patient/year). Severe trauma secondary to syncope relapse occurred in 2% and mild trauma in 4% of the patients.Conclusion A strategy based on early diagnostic ILR application, with therapy delayed until documentation of syncope allows a safe, specific, and effective therapy in patients with NMS.