DIAGNOSTIC EFFICACY OF 24-HOUR ELECTROCARDIOGRAPHIC MONITORING FOR SYNCOPE
DIAGNOSTIC EFFICACY OF 24-HOUR ELECTROCARDIOGRAPHIC MONITORING FOR SYNCOPE
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DOI：
10.1016/0002-9149(84)90628-3
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发表时间：
1984-01-01
影响因子：
2.8
通讯作者：
HEITZMAN, MR
中科院分区：
文献类型：
--
作者：
GIBSON, TC;HEITZMAN, MR
评估了开放式转诊心电图监测服务在确定晕厥致心律失常原因方面的有效性。在5年多的时间里，7364名不同年龄的患者使用双通道记录仪进行了24小时动态心电图（动态心电图）监测。其中1512例（20.5%）因晕厥就诊。在监测期间，15例患者发生晕厥，其中7例发作与心律失常有关，通常为室性心动过速。241例患者报告晕厥前，24例伴有相关心律失常。因此，可诊断的心律失常相关症状仅出现在2%的监测患者中。然而，无心律失常的晕厥或晕厥前期可能被认为是阴性诊断线索，225例（15%）发生。高度房室传导阻滞15例，室性心动过速116例；只有6例（5%）报告了相关症状。发现心房和室性心律失常的年龄相关增量增加。1004例患者中有415例（41%）年龄在60岁或以上，记录了通常与窦房疾病相关的心律失常。根据严格的诊断标准，33例（3%）存在病态窦性或心动过速综合征。许多老年患者（70%）正在服用可能导致心律失常、降压或两者兼而有之的药物。显然，一个开放的转诊24小时动态监测服务很少导致识别晕厥患者相关症状相关的心律失常。它记录了许多无症状心律失常，这些心律失常可能会加重而不是解决老年患者的诊断问题，因为获得的数据可能导致不必要的治疗。晕厥应始终考虑医源性原因。
The effectiveness of an open referral ECG monitoring service in identifying an arrhythmogenic cause for syncope was evaluated. Over 5 yr, 7364 patients of all ages underwent ambulatory 24-h ECG (Holter) monitoring using a 2-channel recorder. Of these, 1512 (20.5%) were referred because of syncope. During monitoring, 15 patients had syncope and 7 of the episodes were related to an arrhythmia, usually ventricular tachycardia. Presyncope was reported in 241 patients, with a related arrhythmia in 24. Thus, an arrhythmia-related symptom that could be diagnostic was present in only 2% of the patients monitored. However, syncope or presyncope without an associated arrhythmia might be considered a negative diagnostic clue and occurred in 225 (15%). High-grade atrioventricular block was present in 15 and ventricular tachycardia in 116; only 6 (5%) reported associated symptoms. An age-related incremental increase in atrial and ventricular arrhythmias was found. In 415 of the 1004 patients (41%) aged 60 yr or more, arrhythmias that are conventionally associated with sinoatrial disease were recorded. Using stringent diagnostic criteria, the sick sinus or tachybardycardia syndrome was present in 33 (3%). Many older patients (70%) were taking drugs that could be arrhythmogenic, hypotensive or both. Evidently, an open referral 24-h ambulatory monitoring service rarely results in identifying relevant symptom-related arrhythmias in patients with syncope. It records many asymptomatic arrhythmias that can compound rather than resolve the diagnostic problem in older patients, because the data obtained could lead to unnecessary therapy. An iatrogenic cause for syncope should always be considered.