| Autor: |
Wang R; Department of Cardiology, Beijing Hospital, Beijing 100730, China Graduate School of Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China., Zhang YF; Department of Cardiology, Beijing Hospital, Beijing 100730, China., Zhang HC; Department of Cardiology, Beijing Hospital, Beijing 100730, China., Wang J; Department of Cardiology, Beijing Hospital, Beijing 100730, China Peking University Fifth School of Clinical Medicine, Beijing 100730, China., Shen SH; Department of Cardiology, Beijing Hospital, Beijing 100730, China Graduate School of Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China., Tong JB; Department of Cardiology, Beijing Hospital, Beijing 100730, China., Liu JP; Department of Cardiology, Beijing Hospital, Beijing 100730, China., Lyu Y; Department of Cardiology, Beijing Hospital, Beijing 100730, China., Chong J; Department of Cardiology, Beijing Hospital, Beijing 100730, China., Wang ZL; Department of Electrophysiology, Beijing Hospital, Beijing 100730, China., Jin X; Department of Electrophysiology, Beijing Hospital, Beijing 100730, China., Sun L; Department of Electrophysiology, Beijing Hospital, Beijing 100730, China., Gao X; Department of Electrophysiology, Beijing Hospital, Beijing 100730, China., Dai Y; Center of Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China., Liang J; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China., Li HT; Department of Cardiology, Puren Hospital, Beijing 100062, China., Zou T; Department of Cardiology, Beijing Hospital, Beijing 100730, China., Yang JF; Department of Cardiology, Beijing Hospital, Beijing 100730, China. |
| Abstrakt: |
Objective: To investigate the value of implantable cardiac monitor (ICM) in the diagnosis and treatment of patients over 60 years old with unexplained syncope. Methods: This was a multi-center, prospective cohort study. Between June 2018 and April 2021, patients over the age of 60 with unexplained syncope at Beijing Hospital, Fuwai Hospital, Beijing Anzhen Hospital and Puren Hospital were enrolled. Patients were divided into 2 groups based on their decision to receive ICM implantation (implantation group and conventional follow-up group). The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up. Kaplan-Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups. A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope. Results: A total of 198 patients with unexplained syncope, aged (72.9±8.25) years, were followed for 558.0 (296.0,877.0) d, including 98 males (49.5%). There were 100 (50.5%) patients in the implantation group and 98 (49.5%) in the conventional follow-up group. Compared with conventional follow-up group, patients in the implantation group were older, more likely to have comorbidities, had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram, and had a lower body mass index (all P <0.05). During the follow-up period, positive cardiac arrhythmia events were recorded in 58 (58.0%) patients in the ICM group. The diagnosis rate (42.0% (42/100) vs. 4.1% (4/98), P <0.001) and the intervention rate (37.0% (37/100) vs. 2.0% (2/98), P <0.001) of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group (all P <0.001). Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group ( HR =11.66, 95% CI 6.49-20.98, log-rank P <0.001). Multivariate analysis indicated that ICM implantation, previous atrial fibrillation, diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope (all P <0.05). Conclusions: ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope, and increases diagnostic efficiency in patients with unexplained syncope. |
