Clinical Predictors of Pacing Device Implantation in Implantable Cardiac Monitor Recipients for Unexplained Syncope.
Clinical Predictors of Pacing Device Implantation in Implantable Cardiac Monitor Recipients for Unexplained Syncope.
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DOI：
10.1016/j.cjco.2022.12.007
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发表时间：
2023-04
期刊：
影响因子：
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通讯作者：
Kusano, Kengo
中科院分区：
文献类型：
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作者：
Tonegawa-Kuji, Reina;Inoue, Yuko Y;Nakai, Michikazu;Kanaoka, Koshiro;Sumita, Yoko;Miyazaki, Yuichiro;Wakamiya, Akinori;Shimamoto, Keiko;Ueda, Nobuhiko;Nakajima, Kenzaburo;Kataoka, Naoya;Wada, Mitsuru;Yamagata, Kenichiro;Ishibashi, Kohei;Miyamoto, Koji;Nagase, Satoshi;Aiba, Takeshi;Miyamoto, Yoshihiro;Iwanaga, Yoshitaka;Kusano, Kengo
植入式心脏监护仪 (ICM) 有助于调查不明原因晕厥的原因，但此后需要起搏装置的可能性和预测因素仍不清楚。我们回顾性分析了因疑似心律失常病因的不明原因晕厥而接受 ICM 插入的患者的数据。数据来自2012年4月1日至2020年3月31日期间获得的全国数据库。进行多变量混合效应生存分析以确定起搏装置植入（PDI）的预测因素，并相应开发了风险评分模型。总共分析了 2905 名植入 ICM 以调查晕厥原因的患者（年龄：72 岁 [范围：60-78]）。在 128 天（范围：68-209）天的中位随访期间，473 名患者（16%）接受了 PDI。在多变量分析中，年龄较大、房颤病史、束支传导阻滞 (BBB) 和糖尿病是 PDI 的独立预测因素。开发了风险评分模型，评分范围为 0 至 32 分。当以最低四分位数得分（0-13分）的患者作为参考时，具有较高四分位数的患者发生PDI的风险较高（第二四分位数：14-15分，风险比[HR]：3.86，95%置信区间[CI]：2.62-5.68；第三四分位数：16-18分，HR：4.67，95% CI： 3.14–6.94；第四个四分位数：19–32 分，HR：6.59，95% CI：4.47–9.71）。在对晕厥患者进行初步评估时，可以轻松评估 4 个已确定的预测因素。它们可能有助于识别需要永久性 PDI 风险较高的患者。
Implantable cardiac monitors (ICMs) help investigate the cause of unexplained syncope, but the probability and predictors of needing a pacing device thereafter remain unclear. We retrospectively analyzed the data of patients who received ICM insertion for unexplained syncope with suspected arrhythmic etiology. The data were obtained from a nationwide database obtained between April 1, 2012 and March 31, 2020. Multivariable mixed-effects survival analysis was performed to identify predictors of pacing device implantation (PDI), and a risk score model was developed accordingly. In total, 2905 patients (age: 72 years [range: 60-78]) implanted with ICMs to investigate the cause of syncope were analyzed. During the median follow-up period of 128 days (range: 68–209) days, 473 patients (16%) underwent PDI. Older age, history of atrial fibrillation, bundle branch block (BBB), and diabetes were independent predictors of PDI in multivariable analysis. A risk score model was developed with scores ranging from 0 to 32 points. When patients with the lowest quartile score (0–13 points) were used as a reference, those with higher quartiles had a higher risk of PDI (second quartile: 14–15 points, hazard ratio [HR]: 3.86, 95% confidence interval [CI]: 2.62–5.68; third quartile: 16–18 points, HR: 4.67, 95% CI: 3.14–6.94; fourth quartile: 19–32 points, HR: 6.59, 95% CI: 4.47–9.71). The 4 identified predictors are easily assessed during the initial evaluation of patients with syncope. They may help identify patients with a higher risk of requiring permanent PDI.